Check and Fix a Claim

A claim has to pass the client’s review rules before it can be filed. Checking tells you whether it does, and names what is in the way if it does not.

Before You Start

You need the User role and a claim in Draft. Most claims are generated from visits; Create on the Claims list adds one by hand.

Check a Claim

1. Open the claim from the Claims list.
2. Select Check Claim.
3. Select the Findings tab to read the verdict.

Result: the claim either promotes to Ready, or the Findings tab lists what is blocking it. Each finding names the line and field it concerns, and its rule code. Checking also fills blanks the claim needs from the chart, such as the patient, the subscriber’s member ID, the payer and the service location’s address.

Errors block the claim. A warning does not, but it is worth reading before you file.

Clear a Finding

1. Select the field the finding names. Cards open into edit mode in place.
2. Correct the value. The finding reads “Edited · checked again when you save”.
3. Select Save Changes. A code that is not in effect on the service date is refused with the reason, such as “CPT 99213 isn’t in effect on Jan 5, 2026.”, and the field stays marked.
4. Repeat until no errors remain. The Findings tab says all findings are resolved and that Check Claim promotes the claim.
5. Select Check Claim.

Result: the claim promotes to Ready and waits for an export batch.

Two findings clear from their own row on the Findings tab rather than from a field. Filing Deadline Passed clears with Record Delay Reason…, which needs the Manager or Administrator role. Provider Not Enrolled offers Add Enrollment…, which adds the provider’s enrollment with that payer.

Tip

If a claim keeps failing on provider or location details, fix the provider or location record instead. Every future claim built from that source inherits the correction, rather than you repairing each claim in turn.

Reopening a Ready Claim

Ready claims are read-only. To change one, select Revert to Draft in the claim’s menu. A Ready claim also goes back to Draft on its own when its visit, the patient’s coverage or a review rule changes, or when an export refuses it.

Related: The Claim Page · Claims · Export Ready Claims · The Claim Loop