Claims overview

the claims tab lets you create, submit, track, and manage insurance claims sent to payers through eggmed’s clearinghouse integration (stedi) accessing claims to access claims go to billing → claims you’ll see an organization wide list of all insurance claims the claims list helps you quickly understand what has been submitted, what needs action, and what has been paid claims list overview the claims list displays key details for each claim, including control # – unique claim identifier patient service date submitted date payer number of encounters total charge status filtering claims you can filter claims using the filters panel to narrow down results based on operational and billing criteria available filters include status draft ready submitted acknowledged rejected paid denied voided additional filters service date (from / to) billing profile payer encounter id filters help you quickly isolate claims that need action, follow up on specific payers, or review claims tied to a particular encounter or date range use search and filters to quickly locate specific claims claim statuses each claim moves through several statuses as it progresses draft – claim is created but not submitted ready – claim is complete and ready to submit submitted – claim has been sent to the clearinghouse acknowledged – clearinghouse or payer has received the claim rejected – claim was rejected and requires correction paid – payment has been received and posted statuses help you understand where the claim is and what action is needed opening a claim click any claim from the list to open the claim details page at the top of the page, you’ll see total charge service date current status available actions may include edit claim (if not submitted) submit claim check status download pdf export csv refresh from encounter void claim (when applicable) claim overview tab the overview tab shows high level claim information, including claim details control number service date status total charge payer patient information name date of birth gender phone number address coverage insurance plan plan type member id group number billing profile billing profile name npi tax id billing address eligibility displays eligibility results if an eligibility check was run if none exists, this section indicates no eligibility was found service lines tab the service lines tab shows procedures and charges included on the cms 1500 claim each service line includes date of service (dos) cpt code modifiers place of service (pos) diagnosis pointer units charge amount allowed amount paid amount adjustments remaining balance this tab reflects exactly what was sent to the payer remittances tab the remittances tab shows insurance payments linked to the claim for each remittance, you can see payer total payment amount number of claims included status (e g posted) date received remittances appear here once an insurance payment has been posted and allocated attachments tab the attachments tab allows you to upload supporting documents before submitting a claim you can upload documents such as clinical notes supporting documentation requested by the payer attachments support common file types (pdf, jpg, png, doc) within size limits once uploaded, attachments are linked directly to the claim events tab the events tab provides a timeline of claim activity this includes claim creation submission to the clearinghouse acknowledgment received payment posted each event includes a timestamp and, when available, a trace id from the clearinghouse this timeline helps with audits, follow ups, and payer communication important notes claims are submitted through eggmed’s clearinghouse integration with stedi rejected claims must be corrected and resubmitted paid claims reflect payments that have already been posted claim balances update based on remittances and allocations