Carepatron allows you to submit and track electronic claims for US-based professional services using our integrated clearinghouse partner, Claim.MD.
This guide explains how to:
Submitting electronic claims
You can submit electronic claims if the payer on the claim has been imported from Claim.MD.
For guidance on creating and submitting claims, refer to: How to Create a Claim
Monitoring claim status
After submission, Carepatron continuously monitors updates from Claim.MD and the payer. You will also receive in-app notifications for any status changes.
To track claim progress:
Go to your Claim List.
Click to open a claim.
Check the claim status in the header.
If available, a reason will display next to the status.
Click the History icon in the header to view:
Updates
Payer messages
Claim.MD communication logs
Claim status definitions
Status | Meaning |
Validated | Ready to submit. Not yet sent to the clearinghouse or payer. |
Submitted | Sent to the clearinghouse; under review or routing to the payer. |
Rejected | Not accepted by the clearinghouse or payer. Requires correction. |
Denied | Rejected by the payer. Must be appealed outside of Carepatron. |
Accepted | Accepted by the payer for processing. |
Paid | Full payment received and linked to the claim. |
Partially paid | Payment is linked, but does not cover the full claim amount. |
Processed | Claim received on an ERA with zero payment after payer adjudication. |
Closed | Might be used for any claim that doesn't fit the other terminal states. |
Resubmitting rejected claims
To fix and resubmit a rejected claim:
Open the rejected claim.
Review the error messages at the top.
Revert the claim to Draft.
Correct all necessary details.
Ensure the resubmission code is present (this is auto-filled if applicable).
Submit the claim again.
Note: Error language may come from the Claim.MD or the payer and may differ from Carepatron’s terms.
Viewing ERAs and adjustments
If the payer enrollment for Electronic Remittance Advice (ERA) is complete:
Payments will be automatically applied to matching claims.
Adjustments will be shown directly in the claim history.
To manage new payer enrollments, ensure ERAs are activated. This enables you to recreate and resubmit claims as necessary.
To view:
Open the claim.
Review the history of payment received messages.
Click View remittance for the full ERA and adjustment breakdown.
Click View payment to see payment details and allocations.
Handling unallocated payments
Sometimes, Carepatron can’t automatically link payments to claims.
To manually reconcile:
Open the Client Billing page.
Go to the Payments tab.
Filter type to Insurance and status to Unallocated.
Select the payment, and click Edit payment details.
Allocate the amount to the correct billing items.
Click Save.
Manually recording payments
You can also manually record payments for Approved or Partially Paid claims.
To record a manual payment:
Open the claim.
Click Add payment in the header.
Enter the payment amount.
Add identifying details (date, payer, reference #).
Allocate the payment to the correct billing items.
Click Save.
Our team will be able to answer any other questions you may have. Just reply via messenger through the Help channel in your workspace.