Claim Rejections

  • Updated

Rejected claims come from an updated processing event or clearinghouse status. After a claim is submitted, the clearinghouse scrubs the claim and determines whether it passes the clearinghouse's first-level and second-level requirements, intermediary requirements, and payer requirements. If the claim file does not meet requirements at any of these levels, the claim will be marked with a rejection status that will be sent to AveaOffice.

The Currently Rejected/Held Claims tab allows you to locate all claims rejected by the clearinghouse, intermediary, or payer scrubbing processes. These claims must be corrected and resubmitted before the payer can adjudicate and pay for the services rendered. 

Locating Rejected Claims 

Once the AveaOffice claim has the updated rejection status, users will see these claims in the Work  Center. Users can get to this page by following the path Work Center > Insurance Claims > Currently Rejected/Held Claims, or by navigating through the Management Center dashboard to the Currently Rejected Claims tile.

Let's review how to locate rejected claims.

  1. Navigate to the Work Center > Insurance Claims > Currently Rejected/Held Claims.mceclip27.png
  2. Select the Organization from the drop-down.mceclip28.png
  3. Click Update.
  4. To view the rejection reason, in the Currently Rejected/Held Claims list, click on the Claim Control Number.mceclip29.png
  5. Open the Processing Events tab. mceclip30.png
  6. This will show whether the payer or the clearinghouse rejected the claim and provide additional information regarding the rejection reason.
  7. From the processing notes you will be able to determine the issue and troubleshoot how to resubmit or correct this claim using the Review Corrections or Resubmit with No Changes steps described in this article.
  8. Note: If the claim rejects at the clearinghouse again, the claim will once again display in the Work Center.

Removing Rejected Claims

If you've received a rejection, but the claim is actually being processed by the payer, you can manually remove the rejection from the Work Center. Click here to learn more.

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