A claim is a mode of communication between an insurance company and a practice with the aim of reimbursement for the services rendered to a patient.
In this article you’ll learn:
How to Create a Claim
1. Under the Manage Bills tab, click on a Bill’s ID to access the bill's details.
2. Click Create Claim.
Note: Make sure there is at least one charge in the bill. If not, click +Add Charge to add the charge.
3. In the pop-up window, select the charges to be included in the claim. All of the bill's charges will be selected by default. Then click Create Claim.
Note: You cannot create the claim if the Date of Service differs for the charges selected. Create separate claims for each Date of Service.
4. Once the claim has been successfully created, you can check the claim details or submit it electronically.
Note: If an error message states that scrubbing is not passed, you can click Create Claim Anyway and address any data issues at a later time. You can also choose Close, make any necessary changes to the bill or patient data to address the issues and then try to Create Claim again.
A claim may not successfully pass scrubbing due to information such as insurance, demographics, etc. You can address the missing data first and then successfully generate the claim. You can find detailed instructions here: https://support.remedly.com/hc/en-us/articles/10867909789975-How-to-Address-when-Claims-Scrubbing-Fails-RCM-
IMPORTANT: you can't submit the claim with Scrubbing not passed label:
When you tackled all the problems flagged by the system, the status of the claim changes to Submitting:
You can view your claim in the Claims tab and track its status: