Occasionally, a claim is rejected by Change Healthcare’s clearinghouse or the payer. These errors typically are due to an error on the claim itself. Artisan has tools to help you find these errors and resubmit the claim.
Locating Rejected Claims
Rejected claims can easily be located in Accounting under Clinic on the Clinic Overview tab within Snapshot. Here, the system will display claims rejected by CH (Change Healthcare Clearinghouse) and claims reflected by the payer. Click on the tile to bring you to the corresponding rejections list.
Claims Rejected By Change Healthcare Clearinghouse
Click on the tile Rejected by CH under Snapshot.
This will pull up all of the claims that currently have the invoice status Rejected by Clearinghouse. This means that the claim was rejected by the Change Healthcare clearinghouse and was not sent to the payer. The columns in this list will display the patient name, date of service, rejections day, payer name, provider, location, rejection reason and a link to the invoice log. You are also able to filter this list by the following:
1. Provider
2. Location
3. Payer
4. Date of service range
5. Sort by different views: Name (ascending or descending), Balance, (ascending or descending), or Date of Service (ascending or descending).
Once you have selected your filters, click Search to apply them. Click Reset to reset the filters.
Hovering over the rejection reason will activate a pop up window with the reasons why the claim was rejected by the clearinghouse. Click on the purple “i” icon to open up the Invoice Log. Clicking on the patient name will pull up the invoice.
The invoice will open up. The Invoice Status will display as Rejected by Clearinghouse with a maroon dot next to the status, indicating that it was rejected. To correct the claim, click on Invoice Action to pull up the menu and click on Edit Claim Details.
This will pull up the Edit Claim Details screen where you are able to make the needed changes to the claim.
Once the claim has been edited, click the Re-submit button in the bottom right corner to re-upload to the Clearinghouse.
The Invoice Status will display as Re-uploaded.
Please note, the claim may be updated and re-uploaded from the patient’s Invoice Summary tab in Accounting as well.
Claims Rejected By Payer
Click on the tile Rejected By Payer under Snapshot.
This will pull up all of the claims that currently have the invoice status Rejected by Payer. The columns in this list will display the patient name, date of service, rejections day, payer name, provider, location, rejection reason and a link to the invoice log. You are also able to filter this list by the following:
1. Provider
Location
Payer
Date of service range
Sort by different views: Name (ascending or descending), Balance, (ascending or descending), or Date of Service (ascending or descending).
Once you have selected your filters, click Search to apply them. Click Reset to reset the filters.
Hovering over the rejection reason will activate a pop up window with the reasons why the claim was rejected by the clearinghouse. Click on the purple “i” icon to open up the Invoice Log. Clicking on the patient name will pull up the invoice.
The invoice will open up. The Invoice Status will display as Rejected by Payer with a red dot next to the status, indicating that it was rejected. To correct the claim, click on Invoice Action to pull up the menu and click on Edit Claim Details.
This will pull up the Edit Claim Details screen where you are able to make the needed changes to the claim.
Once the claim has been edited, click the Re-submit button in the bottom right corner to re-upload to the Clearinghouse. The Invoice Status will change to Re-uploaded.
Please note, the claim may be updated and re-uploaded from the patient’s Invoice Summary tab in Accounting as well.
**All manuals are compliant with HIPAA regulations. No patient information has been released. All screenshots above were taken from a test clinic with fake donor and patient information.**
Tristan Newman
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