Rejections and Denials
Handling claim rejections
Most claims are processed smoothly. However rejections and denials do occur. When a claim is rejected, you will see Rejected as the 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.
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. 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.
Adding resubmission information
Note: If the claim was rejected by the clearinghouse, you do not need to add resubmission information because the claim was not accepted by the payer and no payer claim exists. Only claims rejected or denied by the payer will require resubmission information.
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:
6 - Corrected Claim
7 - Replacement of Prior Claim
8 - Void / Cancel Prior Claim
Note: When resubmitting claims, certain payers may require you to use a specific code, however, most payers prefer using the 7 - Replacement of Prior Claim code rather than the 6 - Corrected Claim code.
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.
After these steps are complete, click the Submit button to resubmit the claim.