How-To Guides

Using the Claims Center

Go to “Financials > Claim Center” via your top menu bar.

Screenshot of a claims management system showing claim records with details such as ID, creation date, creator, type, date of service, patient name, provider, charge, insurance balance, and insurer. The interface has navigation tabs labeled Patients, Appointments, Financials, Clinic, and user info for Sofie Lehtikoski, with options to submit claims and mark submissions.

Each claim is processed via the following 7 steps:

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Open – the note is ready for billing review, and is still open for billing changes (no claim has yet been created)

Created – the claim has been created and is ready to be submitted

Pending – the claim has been submitted, and is pending within the insurer’s adjudication system

Repairable – the insurance company rejected the claim with an error, and the claim needs to be repaired and resubmitted

Issue – your billing team has identified an issue with the claim that requires a call to resolve

Finalizable – a payment or ERA has been received from the insurance company, or the insurance balance of the claim is $0.00, the claim is ready to be reviewed for correct payment amounts then finalized

Finalized — all insurance payments are received as expected

Tip: You may hover over each of the steps in the claims pipeline to see a description within the EHR as well.

Open. There are two ways to create a claim: directly from the note (for a provider with billing permissions), or by reviewing all open notes (for the billing team). 

Screenshot of a claims center dashboard showing patient, provider, location, charges, insurance, and claim status information.

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The Open page of the Claims center allows you to view a list of all of the latter, and go through each note one by one by clicking “Review Open Notes” at the top right.

For each note, please review the billing section of a note to verify that the CPT codes and Place of Service (POS) is as expected. 

Then click “Create Claim”.

Screenshot of a healthcare workflow interface showing a claim form with fields for recipient, CC, sensitivity, and actions including create claim, sign, edit, print, PDF, CSV, and delete. There are links for printing visit balance, submitting patient claims, and downloading a claim form.

If there are no rates, or the charges total up to zero, a claim will not be created, as your clinic is not expecting to receive any payments. The blue action button will then instead read “Finalize” to finalize the billing immediately.

Screenshot of a web workflow interface with buttons for actions such as Unsign, Finalize, Edit, Print, PDF, CSV, and options for Addend and 2nd Provider. It also contains links for Print Visit Balance, Print SuperBill, and Download HCFA 1500 claim.

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If this is in error, or if any rates are added retrospectively, you may at any time before claim submission re-open/unfinalize the note to re-generate the charges, and then repeat the previous step.

If a claim was already generated, first click “View Claim”, then “Actions > Re-open Note”:

Medical insurance claim form on a computer screen showing patient details, claim information, and options to submit or manage the claim.

If no claim was generated, first click “Unfinalize”:

Options panel with buttons labeled Unsigned, Unfinalize, Print, PDF, CSV, Addend, and Delete, with the Unsigned button highlighted in orange and the Delete button in red.

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Created. To submit a claim, simply click “Submit to Insurers” and the claim will be sent to insurers at midnight on the same day.

Screenshot of a Claims Center interface displaying lists of claims, including details such as claim ID, creation date, creator, type, date of service, patient name, provider, charge amount, insurance balance, and insurance provider. The interface has options to filter claims, submit to insurers, and mark submissions as completed.

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The claim is already auto-populated with information from the note and the patient’s registration. Please review for correctness before submitting.

You may make any edits until the submission at midnight. To cancel the submission, you may use “Actions > Re-open Note”.

If a payer was not selected in the patient registration, you will have to select the payer before submitting. For other tweaks, until the claim is submitted, you may also edit the registration directly, and the information on the claim will receive the changes.

Pending. The claim is being processed in the insurer’s adjudication system, and is pending any payments or Electronic Remittance Advice (ERAs), also known as Explanation of Benefits (EOBs), from the insurance company.

Screenshot of Claims Center dashboard showing a table with claim details, including claim IDs, creation dates, types, patient names, providers, charges, insurance balances, statuses, and COB information.

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A claim is pending until a payment is received. When a payment is received, the claim will move to the Finalizable page.

To record the ERA and insurance’s payment amount into the EHR, click “Record Payment…” and apply the claim to the appropriate charges:

Screen showing a form to record a payment, with details for insurance payments including amounts, dates, and billing codes from Sterling R. Satterfield.

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You may filter the charges based on claim number, patient name, date of service, etc.

Where do I find insurance payments (ERAs)?

You can receive ERAs automatically uploaded to your payments and matched to claims by enrolling in ERAs on the 'Manage Billing > E-Payers' page.

Repairable. If a claim appears on the Repairable step, there was an issue with the claim, such as a box that was filled out wrongly, or any formatting issues. The claim must be corrected and then resubmitted to the insurance company. 

A screenshot of a claims management system showing a list of insurance claims with details such as ID, creation date, type, date of service, patient name, date of birth, provider, charge amount, insurance balance, insurance provider, and claim status. The interface includes navigation links, a filter option, and a 'Resubmit to Insurers' button.

First, you will need to create a resubmission and correct the claim, one by one for each of the claims on this list. The claims with IDs in red on the left have not yet been fixed. 

To create the resubmission, either click the red ID, or hover over the denial reasons on the right-most column and click “Create Resubmission”.

A digital claims center interface showing a list of claim records with details such as IDs, creation dates, types, patient names, DOBs, and other information. There is a pop-up window with denial reasons and an option to create a resubmission.

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This will allow you to override the claim and make changes to fix any of the denial reasons given. 

Particularly note Box 22 on the claim form: if the payer assigned a reference number for the rejected claim, you should select “7 - Replacement of Prior Claim” when resubmitting.

A healthcare claim form titled 'EM Visit - Primary Claim (HCFA) #27' with fields filled out for insurance and patient information, including name, date of birth, address, and diagnosis details.

Note that the error messages given by the insurance company typically appear cryptic and use strange codes such as “2010AA-N403”. This corresponds to the more advanced EDI view mode for a claim. For example, the given error:

2010AA-N403: Value of element N403 is incorrect. Expected value for ZIP Code is 9 digits. Segment N4 is defined in the guideline at position 0300. Invalid data: 23123 (HIPAA)

Indicates that the zip code field (element 03. Zip Code) for the billing provider (segment 2010AA-N4) was incorrect, since a 9-digit zip code was given instead of a 9-digit zip code.

You may see the EDI mode for a claim by clicking “EDI” at the top right of the claim and CTRL+F for the given error code.

Screenshot of an insurance claim form detailing various fields such as claimant information, receiver information, billing provider details, and address, with a note about claim errors and a balance of $261.17.

After the appropriate changes are made and saved, you may click “Resubmit to Insurers” for the repaired claim. The claim is now repaired!

Claims Center dashboard showing a table of insurance claims with columns for ID, creation date, type, DOS, patient name, DOB, provider, charge amount, insurance balance, insurance company, COB, and a status icon.

Issue. A claim can be moved to the issue step any time after submission. This can be done via “Actions > Flag Issue”.

A screenshot of an insurance claims management interface showing a 'Flag Claim Issue' window with priority level, issue description, and options for immediate resubmission or logging a call to the insurance company. The background includes a claims center table listing patient claims, with columns such as ID, Reference number, Type, DOS, Patient Name, DOB, Insurance, Member ID, Charge, Issue, and Priority, highlighting an urgent claim for insurance not paid.

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Here, your billing team may record calls to the insurance company or any other actions.

To move the claim out of the Issues page, click “Resolve…” 

Insurance claim resolution dialog box with options for moving claim to queue, including 'Pending,' 'Finalizable,' and 'Repairable.' The 'Repairable' option is selected.

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To resubmit the claim, move it to the Repairable page. To indicate no further action is required from you, move it to Pending. Otherwise, if the issue has been fully resolved and the claim is fine as it is, move it to Finalizable for a final review and check off.

Finalizable. Now the final step is to review your Finalizable claims and make sure that the insurance actually paid the correct amounts.

Claims center webpage displaying claim details for patient Loyce Beatty including creation date, provider Sofie Lehtikoski, charge amount of $376.65, and insurance with Blue Shield California.

To reconcile revenue for each claim and adjust charges where necessary, click “Actions > Adjust Charges”. 

A screenshot of an online billing adjustment form showing charges for two healthcare providers, Loyal B and Blue Shield Cal, with details like date, service ID, amount charged, discount, and total balance due of $138.41.

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If the insurance company balance is not $0.00, or the charges otherwise don’t match the Electronic Remittance Advice (ERA), you may adjust the charges to match.

Select an adjustment reason to describe why the adjustment was made. 

For example, if the insurance did not pay, and your clinic is not appealing the denial, then mark the insurance denial and adjust the charges appropriately:

Screenshot of a medical billing adjustment form showing two charges, one for Loyce B and one for Blue Shield Cal, with amounts, discounts, adjustments, and total balance.

If the claim has an issue and the payment amount was incorrect, and should be resolved by appealing or calling the insurance company, click “Flag Issue” and describe the problem.

Screenshot of a form titled 'Flag Claim Issue' with options to select priority level, issue description stating 'Aetna only paid $50.62 of $120,' and checkboxes for resubmission and logging an insurance call, along with a blue 'Flag' button.

Finalized. The claim is now finalized. Congratulations! 

Screenshot of Claims Center webpage showing a table listing claims with columns for ID, created date, type, DOS, patient name, provider, charge, insurance balance, insurance provider, submission method, and COB.

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Resubmitted claims will also be displayed on this page.

If you need to create a secondary claim for the visit, you may click “Create Secondary Claim” to send the claim to another payer. The previous steps will be repeated.

That’s a wrap for the Claims Center. To see this process from a monetary or accounting angle instead, you may also use the Accounting Center, accessed via “Financials > Accounting Center”. This shows you a breakdown of all paid and unpaid charges, payments, and on, in your EHR.