Status and Remittance
Summary: We help you track the status of claims and payments. We can provide information about what the payer approved for reimbursement and help you add the payment details when available.
Status
The status of a claim can be one of the following:
- Not Submitted - the claim has been created but not yet submitted
- Queued for Submission - this is when a claim has been created but not yet submitted (there’s a 1-hour delay from when a claim is created before submission to the clearinghouse to allow time for changes)
- Submitted - the claim has been submitted
- Submitted Externally - the claim has been marked as being submitted outside of Sessions Health
- Reopened - a previously submitted claim that has not yet been submitted
- Rejected - when the clearinghouse or Sessions Health rejects the claim
- Denied - when the payer denies the claim
- Processed - when the claim has received remittance / ERA for all services
- Voided - a canceled claim
Once a claim has been submitted, you may click on the Status tab to track events. As we receive information from the clearinghouse, we also include the clearinghouse responses for more detailed information. When a claim is first created, we'll check the status at the clearinghouse in 6 hours. After that we check for status updates every 6 hours.
If an ERA is received from the payer, we will automatically apply the payment information and mark the claim as paid. You may see the breakdown of this information on the Remittance tab for the claim.
Service - The CPT code billed
Price - The amount charged
Client Owes - The portion the client is responsible for
Insurance Paid - The amount the payer remitted
Write-Off - The difference between the price and what the payer stated was owed by the client and insurance
Note: Payers typically only allow enrollment of ERAs through a single clearinghouse. If you are enrolled for ERAs for any payers through another clearinghouse you may need to cancel those enrollments before being approved through Sessions Health.
There's an important aspect of the system that is important to clarify to understand the relationship between submitting claims through a clearinghouse and the financial transactions that occur.
Payment of electronic claims is a direct exchange of funds between you and the payer. We will not have any insight into this transaction. Most payers offer provider portals where you may look up the transaction IDs. This varies from payer to payer.
Our system receives notification of what the insurer has approved for reimbursement, but does not indicate that the actual transfer of money has completed or include transaction IDs. It isn't uncommon for remittance information to be received by Sessions Health before the payment hits your account. If more than a week passes after you receive a payment report and you still haven't received the payment, we recommend that you follow up with the payer.
Secondary Insurance
You may enter Secondary insurance payments on the Remittance tab for a claim. Primary will come back with the patient responsibility and Secondary is submitted with the patient responsibility amount.
Manually adding remittance information
There are some fairly common scenarios where remittance information may need to be manually added. These include:
- Receiving remittance before an ERA is processed
- When the payer doesn't support ERAs
- When you are not enrolled for ERAs
- When ERA enrollment is in progress
To manually add remittance information, navigate to the Remittance tab on the claim and then click the Add Remittance button. You may then enter the relevant information for each column according to the explanation of benefits received from the payer. You may calculate the write-off by clicking the calculator icon at the right-hand side of each service row.
