The claims submission and tracking phase ensures that all your appointments and documentation are submitted as clean, error-free claims.
Completing this step helps you get paid faster, avoid denials, and manage your claims from one central place.
In this guide, we will cover:
Creating claims from completed appointments
Claims in Carepatron are generated from appointments that already have insurance details.
Open the completed appointment.
Select View.
Review that the client, payer, service, DX codes, and provider are correct.
Select +Add claim. You can also click on the arrow beside Create invoice and choose Create claim.
You will get a notification in the lower right portion of the screen that the claim has been created and is ready for viewing.
Validating claim details
Before submitting, review all pre-filled information to ensure accuracy and help prevent claim denials.
Open the claim. You can open and view a claim using any of the following methods:
a. Billing > Claims tab > Select the claim draft
b. Appointment > View > Claim
c. Clients > Select client > Billing > Claims > Claim draft
Then, complete the missing information.
Click Validate.
Submitting electronic claims through the clearinghouse
Electronic claims are sent through the clearinghouse for faster processing.
Open the validated claim
Click Submit electronically.
Once it is successful, you will notice that the status will changed to Submitted.
Tracking claim statuses
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 or View claim from the in-app notification.
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
This is an example of the claim history:
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. |
Creating secondary claims
Some situations require secondary claims, such as coordination of benefits or special handling.
Open the original claim.
Click Create Secondary Claim.
Choose from the list of clients' policies.
Complete the necessary steps.
Create the secondary claim.
Insurance Guide Series
Our team will be able to answer any other questions you may have. Just reply via messenger through the Help channel in your workspace.