Executive summary. Read the rules that hold a claim back before it reaches a payer, and understand why being stopped here is cheaper than being denied later.
Definition
A claim edit is a rule that refuses to let a claim be sent while it carries a defect the rule recognises.
What to do
Open Billing, then Claim Edits. The screen summarises which rules are active and what they have caught.
Read a rule to see what it looks for. A rule names the defect it recognises, not merely a code, so you can tell whether it is the right rule for what you are seeing.
Where a claim is being held, the edit that held it is named on the claim itself. Start from the claim rather than from the rule list when you have a specific claim in mind.
Why this is worth the interruption
A claim stopped here has not been sent, so there is nothing to appeal, nothing to resubmit and no clock running. A claim denied by a payer for the same defect costs a rework cycle and delays payment by the length of that cycle.
The edits do not rewrite anything on your behalf. They refuse and they say why. A rule that quietly corrected a claim would be a rule that changed what you told a payer without asking.
Frequently asked questions
Can I send a claim anyway, past an edit?
Not silently. Overriding is a deliberate act with its own record, so that when a payer asks later why the claim went out in that state, there is an answer with a name against it.
Referenced standards and further reading
- Attergo Knowledge Center ↗Attergo
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