Work a Claim Review Item

A claim that fails the review rules arrives as a work item with its findings already listed against the fields at fault. Working it from the queue is the same job as checking a claim, with the queue moving you along.

Before You Start

You need the User role and a Claim Review queue with open items. There is one per practice day, such as Claim Review · 09/29/2026. Items are labelled with the claim and its error count.

Clear the Findings

1. In the sidebar, select Work Queues.
2. Open the day’s Claim Review queue.
3. In the queue list, select an item. The workspace shows the claim, with its findings in the Problems tab of the side panel and a mark on each field they concern.
4. In the Problems tab, select a finding. The workspace moves to the field it names.
5. Correct the field. Your first edit claims the item and moves it to In Progress. The Changes tab lists what saving and completing will do.
6. Select Complete. Your edits save first, then the item closes and the processor advances.

Result: the claim re-checks. A clean result promotes it to Ready and the processor advances to the next item.

The bar at the bottom also offers Skip and Save Changes, which saves your edits and keeps the item open. On a finding that the filing deadline has passed, a Manager or Administrator who also holds the User role can select Record Delay Reason… on the finding’s row. The claim’s raw EDI is under View Raw EDI in the item menu.

When Completion Is Refused

Completion validates before it closes anything. If a finding still blocks the claim, the bar says which and the item stays where it is, so it never closes over an unresolved problem. If someone else changed the claim since you opened it, the bar reads “Not resolved. Your changes weren’t saved” with Reload, which drops your workspace edits; see A Save Was Refused.

Corrections That Belong Elsewhere

Some findings are really about the patient or the visit rather than the claim. Where a correction belongs to the master record, saving offers to write it back to the patient or insurance record, at a prompt such as Update Patient Record?, so the fix travels beyond this one claim. If that record changed since you opened the item, the dialog refuses the write-back with “The claim keeps your edits.” and offers Reload.

Related: Check and Fix a Claim · Work a Queue Item · The Queue Processor · Claims