Claim Filters
The Claim Filters feature allows you to create customized views of your claims based on specific criteria. This functionality replaces the previous Claim Grouping feature and provides a more flexible and visual way to filter and organize claim data.
Claim Filters are commonly used for reporting, tracking claim status, identifying issues, and managing workflows such as paid vs. unpaid ERAs or claim errors.
Filter Types: Personal vs Account
Claim Filters can be created as either Personal or Account filters.
Personal Filters: Visible only to the user who created them.
Account Filters: Shared across all users in the account and used for team-wide workflows.
Any user can create filters. Account-level filters are intended for shared use across your organization.
Creating a New Filter
To create a new filter, click Add New Filter, then enter a name that clearly identifies the purpose of the filter (for example, “Rejected Claims” or “Paid ERA”).
Once created, you can begin adding conditions to define which claims are included.
Filter by and Value
To build your filter, select a field from the dropdown menu and enter a value.
You can add multiple values within the same condition (OR logic) or create additional filter blocks (AND logic) to refine your results.
Use New Filter Block to continue building more complex filtering logic.
Building Filter Logic
Claim Filters use a flexible logic system that allows you to combine multiple conditions using OR and AND rules.
Same Field = OR Logic
When you use the same field with multiple values, the system applies OR logic. This means any of the values can match.
Example:
Payer Name = Aetna
Payer Name = Blue Cross
This returns claims where the payer is Aetna OR Blue Cross.
Different Fields = AND Logic
When you combine different fields, the system applies AND logic. This means all conditions must be met.
Example:
Payer Name = Aetna
Claim Status = Rejected
This returns only claims that match both conditions.
Combining AND + OR
You can combine both types of logic to create more advanced filters.
For example:
(Payer Name = Aetna OR Blue Cross) AND Claim Status = Rejected
This allows you to narrow down results while still including multiple possible values.
Managing Filters
All filters are displayed in the left panel, where you can search, select, edit, or delete them.
Once a filter is selected, you can update its conditions and click Update Filter to save changes.
Using Filters for Reporting
Claim Filters can be used to quickly generate reports based on specific criteria. Once your filter is created, you can apply it within the reporting tools to analyze claim data more efficiently.
Common use cases include:
- Tracking paid vs. unpaid ERAs
- Identifying rejected claims
- Monitoring claims by payer or provider
- Reviewing claim errors and messages
Important Notes
- The Claim Filters interface has been redesigned to improve usability and clearly show how conditions are structured using AND/OR logic.
- The layout is responsive and may adjust depending on screen size. In smaller windows, elements may stack vertically instead of displaying side-by-side.