Manage Claims
- 27 Feb 2025
- 4 Minutes to read
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Manage Claims
- Updated on 27 Feb 2025
- 4 Minutes to read
- Print
- DarkLight
- PDF
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The Manage Claims page highlights claims requiring attention. 
Video edited on Kapwing
- Click on Manage Claims in the left-hand navigation menu.
Graphs
Recent Uploads Graph
This graph displays claim activity for the past seven days. There are four claim activity categories. Click on each category to view specific claims:
- Rejected claims
- Transmitted claims
- Pending Approval
- Deleted claims
Recent Transmits Graph
This graph shows the past 30 days of transmitted claims, categorized as:
- Transmitted: The claim was submitted once.
- Re-Transmitted: The claim was submitted multiple times.
Claims That Need Attention
Important! Check with the Payer's EDI Department
Payers maintain two databases for claims: one managed by the EDI department and another by Provider Services or Customer Service. When a claim first arrives, it undergoes front-end edits on the EDI server, which can take up to a week. During this period, Provider Services is unaware of the claim.
If the EDI department rejects the claim, Provider Services will not be aware it was ever submitted.
Once the claim clears front-end edits, it moves to adjudication, at which point Provider Services acknowledges its existence. This is why calling Provider Services before the claim clears edits may result in being told they never received it.
Rejected Claims
Rejected claims are those denied by Claim.MD, the payer’s EDI vendor, or the payer itself.
If a claim is rejected, click to display a list of claim errors:
- Red errors: Indicate a rejected claim.
- Yellow errors: Indicate potential rejection and require review before submission.
- Click an individual claim to open the View/Edit Claim page, where errors can be corrected based on explanations at the bottom.
- Check a claim record in the Rejected Claims list to select it for an action. Use the Selected Actionsdropdown to:
- Transmit: Resend a reviewed claim.
- Re-validate: Run Claim.MD validation edits again. Claims passing validation move to pending approval, while failed ones return to the rejected list.
- Submit Void: Changes claim frequency code to '8' (Void) and applies the earliest ICN # if available.
Claim Rejection Entities / Events
Use Show History / Notes to investigate where a claim was rejected:
- Claim.MD
- Payer's Trading Partner
- Payer Directly
Click 
to view History / Notes.
Archiving a Rejected Claim
Archiving removes inactive claims from the active view while preserving historical data.
- Click the red archive button at the bottom left of the screen.
- Confirm archiving in the pop-up window.
How to Un-Archive a Claim
To un-archive a claim:
- Search for the claim on the Search page.
- Click the claim from the list.
- Click the Save Claim button to restore it.
If the "Transmit Approval" setting is turned off, make any necessary changes before clicking Save Claim, as this action will send the claim back to the payer.
Pending Approval
Claims that Claim.MD did not find issues with are ready for approval and submission to the payer. Click the button to submit them.
The Results window displays the number of claims marked for transmission. Click . Any claims rejected by Claim.MD that require corrections will be shown immediately. Refresh the page to confirm there are no rejected claims per Claim.MD standards.
More Information
Claims can be configured for automatic transmission in the Account Settings menu.
Missing Acknowledgement Alert
This alert indicates that Claim.MD successfully transmitted the claims but has not yet received confirmation of receipt. The time frame for missing acknowledgments varies by payer, but a response is typically expected within 48 hours.
Potential reasons for a missing acknowledgment include:
- The payer has not processed the claim file as expected.
- The payer has the claims but has not returned a confirmation or rejection status.
- The payer is experiencing processing delays, and responses may be delayed.
- The provider's setup in the payer’s system is incomplete, preventing status messages.
We recommend contacting the payer to confirm claim processing. If the payer has not received the claims within a few days, re-transmission is advised.
To re-transmit claims, click . Select the necessary claims in the View Claims list, choose Transmit from the Selected Actions dropdown, and then click Transmit Selected in the pop-up window.
More Information
If a payer acknowledgment, rejection, or ERA is received, these alerts will automatically clear. Otherwise, they will remain on the list for follow-up.
ERA Alert
This alert indicates that Claim.MD expected an ERA response within the timeframe set in the ERA Alert Settings (default is 30 days but can be modified). Contact the payer to confirm claim processing. If the payer has not received them, consider re-transmitting.
To re-transmit, click , select all claims approved for transmission, choose Transmit in the Selected Actions dropdown, and select in the pop-up window.
Claim Reminder
This is a user-added reminder for an individual claim. See View/Edit Claims for instructions on adding reminders.
NCCI Alert
This alert signifies that a claim contains information that may lead to rejection. It can be disabled in Account Settings.
Manage Claim Views
My Reminders / All Reminders
This dropdown allows users to filter between their own reminders and all user reminders.
Claim Grouping Dropdown
Located in the upper-right corner of the Manage Claims page, this dropdown filters claims by groupings such as individual providers, rendering physicians, or NPI. Claim Group settings can be managed in the Claim Grouping tab in Settings.
Remember
If a specific provider is selected in the Claim Group dropdown, reset it to All to view all provider information.
Claim Lists
- Additional Claims List: Displays claims needing attention, such as rejected, pending, or flagged alerts.
- Cleared Response Alerts (Past 30 days): Shows alerts cleared by selecting Remove Alert.
- Cleared ERA Alerts (Past 30 days): Displays ERA alerts cleared in the past 30 days.
- Archived Today/Yesterday: Lists claims archived in the last two days.
- NCCI Alerts (Past 30 days): Displays claims flagged for non-standard data based on payer guidelines.