How to find a claim and read what happened to it

Executive summary. Open the claims queue, find the claim in question, and read its own record rather than reconstructing the story from memory.

Definition

The claims queue lists claims built from billable encounters, each carrying what was submitted and what came back.

What to do

Open Billing, then Claims. The queue lists claims with their current status.

Open the claim you are asking about. Its own page carries what it is, rather than a summary assembled for the list.

Read the status first. It tells you whether the claim is still with you, has been transmitted, or has had an answer.

Where a claim was submitted, it carries the reference the clearinghouse acknowledged it with. That reference is what a payer or clearinghouse can look the claim up by, so it is the thing to quote when you call.

What the system does

A claim records the evidence of its own transmission. A claim that says it was submitted carries the time it was sent and the reference it was sent under, together, because a claim asserting it was sent with nothing behind that assertion is not something anybody can act on.

Encounters are the other end of the same work, under Billing, then Encounters. If you are asking why a claim does not exist yet, the encounter is where that answer lives.

Frequently asked questions

The claim I expected is not in the queue. Where do I look?

Start at the encounter. A claim exists once a billable encounter has been recognized and built, so an absent claim is usually a question about the encounter rather than about the claims queue.