Claim Issues: Source and Type

Claim Issues are added to claims to specify further what prevents the claim from being processed. Issues are created with two variables: the issue Source (like the payer, practice, etc) and the issue Type. Let's review both sections together.

User Permissions

Admin-level user profiles can create, manage, assign, and update claim issues without additional user permissions. Organization Users and Managing Organization User permissions are limited to assigning and updating claim issues and will require Edit-level permissions under Insurance Claim Access in the user profile. To read more about user types and permissions, click here.

Create and Manage Claim Issue Sources

A claim issue source is a category that describes the root cause of the issue. Let's review how to create and manage claim issue sources.

1. Navigate to Managing Organization Admin > Configuration > Claim Issue Sources.
2. Click Create Claim Issue Source.
3. Type in the Name of the issue source.
4. Click Create to complete the process.
1. Navigate to Managing Organization Admin > Configuration > Claim Issue Sources.
2. Click Edit next to the source you wish to update.
3. Make the desired updates.
4. Click Save to complete the process.

Create and Manage Claim Issue Types

When a claim has a problem, the issue type provides additional clarity about the nature of the problem by tying each Claim Issue Type to a Claim Issue Source. Let's review how to create and manage claim issue types.

1. Navigate to Managing Organization Admin > Configuration > Claim Issue Types.
2. Click Create Claim Issue Type.
3. Type in the Name of the issue type.
4. Update the Source dropdown.
5. Click Create to complete the process.
1. Navigate to Managing Organization Admin > Configuration > Claim Issue Types.
2. Click Edit.
3. Update the desired fields.
4. Click Save to complete the process.