Rejections and Denials
Handling claim rejections and denials
Most claims are processed smoothly. However rejections and denials do occur. When a claim is rejected, you will see Rejected as the status. When a claim is denied by the payer, you will see a Denied status.
Note: Claims that are rejected will appear in the Needs Attention area of your Home page and in your Daily Digest email. You may also search for rejected claims in Insurance > Claims tab and filter the status to Rejected. You will need to mark the rejected claim as Reviewed, correct it, and then resubmit the claim.
Correcting a rejected or denied claim
Step 1. Review the error message
You may review the error messages from the clearinghouse by clicking on the Expand link associated with the rejection event. You can find more details regarding error messages on the Claims Errors article. If you aren't certain what a claim rejection error message means, please contact support@sessionshealth.com
Step 2. Mark the claim as reviewed
Once you have reviewed the claim, click the Mark as Reviewed button. Otherwise, the claim will continue to show up in the Needs Attention section of your Home page and in your Daily Digest email.
Step 3. For denied claims, reopen the claim for edits
Click the '...' menu at the top of the claim and select Reopen for Edits.
A popup will ask if you want to replace the claim. Select 'Yes' to make corrections that you wish to resubmit. You will be asked to include the Payer Claim Number of the original claim which you can find in the heading of the claim. If the payer didn't include a claim number on the response to the clearinghouse, you will need to contact the payer.
Note: If the claim was rejected by the clearinghouse, you do not need to reopen the claim or add resubmission information because the claim was not accepted by the payer and no payer claim exists. Only claims denied by the payer will require resubmission information.
Step 4. Correct the claim and resubmit
Be sure to make any changes to correct the problem described by the error message. This may involve editing the information in the claim's Details tab and updating other information in your account. For instance, if the client's zip code is in the wrong format, you may need to update both the claim and the client's record. This is to correct both the current claim and prevent future claims from being rejected.
Voiding a claim
If you wish to void a previously submitted claim, click the '...' menu at the top of the claim and select Void Claim.
You will prompted to confirm that you want to void the claim. After confirmation, you will be asked to include the Payer Claim Number of the original claim which you can find in the heading of the claim. If the payer didn't include a claim number on the response to the clearinghouse, you will need to contact the payer.
Manually change the resubmission code
Within the claim, click the Details > Other tab. Next click Edit in the Resubmission information section. You may then select the appropriate Resubmission Code.
You will be able to select from these options:
7 - Replacement of Prior Claim
8 - Void / Cancel Prior Claim
Next, add the original payer's claim number in the Original Ref. Number field. You can find the payer's claim number in the claim information section at the top of the claim.