How to create and submit insurance claims

create and submit insurance claims to request payment from an insurance payer for services provided to a client b efore you start before creating a claim, make sure that the client has insurance coverage added (client profile → coverage) the insurance payer is set up (settings → billing → payer setup) the service has been completed and is eligible for insurance billing an invoice or encounter exists for the service if coverage or payer information is missing, claims cannot be submitted w here claims are managed all claims are managed from the claims section path go to billing → claims this page shows all claims across your organization, along with their status h ow to create a claim 1 go to billing → claims this page shows all claims across your organization and their current status 2 click new claim 3 in the create claim modal, enter the required information encounter id (required) coverage id (optional) billing profile (optional) payer (optional) 4 click create claim the claim is created in draft status and can be reviewed or edited before submission u nderstanding claim statuses claims move through different statuses as they progress through the billing workflow each status shows where the claim is and whether any action is required check this article to understand more claim statuses check this article to understand more claim statuses https //shared archbee space/doc/9f5licnutxkmtfjqzzczb/pas7lg5onl1qo7kpv9pvq draft the claim has been created but has not been submitted ready the claim is complete and ready for submission submitted the claim has been sent to the payer acknowledged the payer has received the claim awaiting payment the claim has been accepted and is waiting for payment paid payment has been received for the claim rejected the claim was rejected and requires correction before resubmission denied the claim was reviewed by the payer and will not be paid voided the claim was cancelled and will not be processed or paid statuses help you track the claim’s progress and understand what action, if any, is needed at each step h ow to submit a claim 1 open the claim from the claims list 2 review the information in the overview tab 3 click submit claim once submitted the claim status updates to submitted the claim is sent to the selected payer no further edits are allowed unless the claim is corrected or voided m anaging a submitted claim from the claim details page, you can check status to see updates from the payer download pdf for records export csv for reporting void claim if it was submitted in error view related details in service lines remittances events attachments all claim activity is logged for audit and tracking purposes w hat happens after a claim is paid when a claim is marked as paid payment can be recorded in eggmed the invoice balance is updated remaining balances can be billed to the patient if needed claims marked as paid appear in reporting and remittance tracking i mportant things to know claims are submitted manually to give you full control submitting a claim does not automatically close an invoice claims can be voided if submitted incorrectly correct coverage and payer setup are required for successful submission c ommon mistakes to avoid submitting a claim without coverage always confirm insurance coverage first submitting before recording copays copays should be recorded as patient payments ignoring rejected claims rejected claims must be corrected and resubmitted