The Claim Page

One claim in full: what it says, what review found, and what you can do to it. This is where a claim is repaired; Claims is where you find it.

Who Can See It

User, when the client is licensed for claims. Void Claim, Resend Claim, Rebill to Another Payer and Record Delay Reason… also need the Manager or Administrator role, and are missing without it.

The Header

The claim number, its status, and a summary line naming the patient, the payer and the amount charged. A findings count sits beside the status and jumps to the Findings tab. Claims marked for replacement or void carry a chip saying so. A claim billed to a later payer carries a Secondary or Tertiary chip, and a primary that has a secondary carries Primary. The date-of-service range ends on the latest service date or line To Date.

The filing button follows how the payer takes claims: Export 837P for an electronic plan, Print CMS-1500 for a paper one. View Raw EDI sits beside it; everything else is in the header’s menu.

The Tabs

Tab	What it holds
Overview	The claim itself, in six cards, and the claim lines
Findings	What review found, counted in the tab
Acknowledgments	What the clearinghouse and the payer answered, counted in the tab: Received, From, Result, Status, Line and Message. Empty, it reads “No acknowledgments received yet.”
Remittances	What the payer sent back against this claim
Transactions	The ledger entries this claim produced
Resolutions	Denial work, counted in the tab. A claim combined into another reads Combined into with a link to that claim, and the claim that absorbed it lists it as Absorbed with a link back
Activity	Notes, decisions, status changes and work queue items, newest first, including notes written on the claim’s remittances. The Billing chip narrows it to secondary billing, such as a secondary claim being created or voided. See Record Activity

What Overview Carries

Cards open into edit mode in place, and a save bar appears once anything changes. Leaving with unsaved work asks first. If someone else saved the claim first, the bar shows Reload in place of Save Changes, which drops your edits; see A Save Was Refused. A group inside a card collects the fields one CMS-1500 box asks for together.

Card	Fields
Claim	Claim Number, External ID, Visit, Filing Date, Filing Deadline, Delay Reason (with Clear), Assumed Care, Relinquished Care, Narrative. The Condition group: Related to Employment, Auto Accident, Auto Accident State, Other Accident, Condition Codes. The Dates group: Onset Date, Onset Qualifier, Other Date, Other Date Qualifier, Unable to Work From, Unable to Work To, Hospitalized From, Hospitalized To. Once they apply: Export Batch, Exported At, Status Asked At, Accepted On, Payer Claim #
Patient	Patient, First Name, Last Name, Middle Name, Date of Birth, Gender, Medical Record Number, SSN, Phone, Address Line 1, Address Line 2, City, State, ZIP Code, and Insured Name when a Self coverage bills under another name
Service location	Location, Facility, NPI, Address Line 1, Address Line 2, City, State, ZIP Code, Secondary ID, Secondary ID Qualifier, CLIA #
Payer / plan	Insurance, Payer, Payer ID, Filing Indicator, Group #, Prior Authorization #, Referral #, Submission Method, Property & Casualty Claim #, Accept Assignment, Benefits Assignment, Release of Information, Amount Paid, Clinical Trial Number. The Other coverage group: Other Insured First Name, Other Insured Last Name, Other Insured Middle Name, Other Member ID, Other Group #, Other Relationship, Other Payer, Other Payer ID, Other Filing Indicator
Subscriber	First Name, Last Name, Middle Name, Sex, Relationship, Member ID, Date of Birth, Address Line 1, Address Line 2, City, State, ZIP Code, Phone
Providers	Billing: Name, NPI, Taxonomy, Tax ID. Rendering: Provider, First Name, Middle Name, Last Name, NPI, Taxonomy. Referring: Provider, First Name, Middle Name, Last Name, NPI, Role, Secondary ID, Secondary ID Qualifier. Supervising: Provider and an Incident-To switch, greyed until a provider is picked; read-only, Name, NPI and Files As. Purchased service: Purchased Service NPI

The Visit picker lists only this patient’s visits. View Insurance Coverage opens the patient’s coverages. Changing Insurance always switches the payer fields; Keep Current Fields keeps only the subscriber’s. Patient and Subscriber are marked “as filed”, and a save that changed them can offer to update the patient’s own record. On a crossover, which the earlier payer forwarded, Submission Method reads Crossover and cannot be changed.

ClaimPod numbers every claim it creates as CLM- followed by ten digits. You can give a claim a number in your own format, but not in that CLM- form, which could clash with a later one. Leave Claim Number blank to take the next.

Some fields travel in pairs. An auto accident needs its state, a date needs its qualifier, and a from date needs a to date that follows it; saving half a pair is refused, and the message names the pair.

Filing Deadline counts down the payer’s limit and colours as it runs out, or reads “No filing limit set on the plan”. On a secondary claim the count starts when the primary payer decided the claim, so a slow primary does not use up the secondary’s window. A Medicare secondary still counts from the date of service.

External ID is your number for this claim. It goes out on the electronic claim, prints in box 26 of the CMS-1500 (up to 14 characters), and comes back with the payment so ClaimPod can match it.

Claim Lines

Column	What it shows
#	Line number
CPT	The billed procedure
Modifiers	Modifiers on the line
ICD-10	The diagnosis it points at
POS	Place of service
Service Date	When it happened, or when a multi-day service began
Charge	What is billed
Units	How many
Adjudication	On a filed claim: Answered, Paid, Denied or Awaiting Payer for each line
Unit Type, NDC Code, NDC Qty, NDC Unit	The unit qualifier, and the drug code, quantity and unit
Narrative, To Date, EMG, EPSDT, Family Planning, Purchased Charge	The note, the last day of a multi-day service, three flags, and the outside-lab charge
Performed By	Who rendered the line, with an Incident-To or coverage-arrangement tag. “Billed provider” when it matches the claim

Optional columns show by priority when there is room; the column menu marks the rest “No room”, and a narrow table folds their values under CPT. Add Line is in the card’s menu. The code cells take a pasted list and offer only codes in effect on the service date.

Findings paint the line and the field they concern. A save that breaks a rule outright, such as a code not in effect on the service date or an NPI that is not 10 digits, is refused and marks the cell. An edited field’s finding reads “Edited · checked again when you save”.

Actions

Most actions are not offered at all unless the claim is in the right state. A missing action needs the claim moved on; a greyed one tells you what it is waiting for.

Action	What it does	When it is offered	When it is offered but greyed
Check Claim	Runs the review rules	Draft only	While a check is running
Export 837P	Opens Export Claim, whose Deliver to Connection starts on the connection you used last, else the first active one. Export files the claim in a new batch	Ready, and not imported, a stub, a crossover or superseded	When a batch already holds it, which the tooltip names
Print CMS-1500	Files the claim and prints it on the form	As above, for a claim whose Submission Method is Paper	As above
View Raw EDI	Opens a side sheet with the generated segments	Only when the claim has raw EDI stored	-
Copy Claim ID, Open in New Tab	Utilities	Always	-
View CMS-1500	Opens the claim laid out on the form, as a copy	Any claim that is not a stub	-
Check Claim Status	Downloads a 276 status inquiry	Filed, with an External ID, not a stub or superseded	-
View History	Shows who changed the claim and what they changed	Always	-
Revert to Draft	Reopens a Ready claim	Ready only	-
Cancel Visit	Cancels the claim’s visit with a reason, which removes this claim and stops the visit billing, for a duplicate or an encounter that should not bill	Draft or Ready, on a primary claim with a visit	-
Record Overpayment Request	Records a payer’s letter asking for money back: Payer, Amount Owed, Letter Date, Refund Due, Payer Reference, Decision	Paid, not a stub, voided or superseded	-
Open Resolution Workspace	Works the denial	Denied, with at least one resolution	-
Bill Secondary	After a confirmation, creates the claim for the next payer, which the menu names, moves the open balance to it and opens it. A secondary offers Bill Tertiary the same way	A primary or secondary with another coverage on file, no next claim yet, an open balance, and Submitted, Accepted, Paid, Settled or Denied	Until the payer’s decision has posted, and while a remittance on the claim is held, unless the only held one is a secondary payer’s remittance waiting for this secondary claim
Resend Claim	Files again as a new first submission, frequency 1: voids the claim, reverses its charge and opens a new draft from the chart. A Submitted claim asks Why are you resending it?	Rejected, or Submitted with no remittance and no payer claim number. Manager or Administrator	-
Rebill to Another Payer	Picks another of the patient’s coverages under Bill To, then opens a new claim to that payer	A primary with a visit, Submitted, Accepted, Denied or Settled, nothing paid. Manager or Administrator	With no other coverage active on the service date, or a held remittance
Replace & Refile	Refiles as a correction, frequency 7	Filed, and not a stub, Rejected, voided or superseded	Until the payer’s claim control number arrives with the remittance
Delete Draft	Discards the claim. Its visit returns to Ready and can generate a claim again, so the dialog offers Cancel Visit Instead for a visit that should not bill	Draft only	-
Void Claim	Withdraws the claim from the payer, frequency 8, with a Reason recorded in Activity. Nothing is refiled	As above, for a Manager or Administrator	As above
Record Delay Reason…	On a Filing Deadline Passed finding: records the Delay Reason, Evidence Date and Note	Draft or Ready. Manager or Administrator	-
Add Enrollment…	On a Provider Not Enrolled finding: adds that provider’s enrollment with the payer	Draft or Ready	-

The first four sit in the header. The rest, down to Void Claim, are the header’s menu in order, and the last two sit on their finding’s row. A greyed item stays in the menu, and hovering or focusing it says what it is waiting for.

The CMS-1500 View

View CMS-1500 opens the claim on the form, as its own page. It is a copy, watermarked NOT FILED until the claim is filed and COPY afterwards. Print sends it to your browser’s print dialog; Download PDF saves it. Neither files anything: the form a payer gets comes from a print batch.

A filed claim always shows the form it was printed with, even after the template changes. A claim the form cannot hold shows the reason in place of the form: more than 12 diagnoses, more than 50 lines, a single line charging $100,000 or more, or more than one purchased service. A claim with no lines opens the page too, and reads “This claim has no service lines, so there’s no form to show.”

Banners

The claim tells you at the top when something about it is unusual. A pinned note and the last three banners can show together; the others show one at a time, the most pressing first.

Banner	What it means
A pinned note	Someone pinned a note to this claim. It sits above every other banner and shows who wrote it - see Record Activity
Awaiting matching 837 import	A stub. Patient and provider details fill in when the 837 arrives
Rejected before adjudication	Refused by the clearinghouse or the payer, with what it said and Resend Claim
Member ID changed	The member ID changed after filing, so the payer has the old one. Offers Replace & Refile
This claim was denied	With the reason count, and a link into the resolution workspace
Voided by	A later claim voided this one, and links to it
Rebilled to	Rebilled to another payer, naming it, the new claim and the day
Rebill of	This is the rebill, naming the original claim and its payer
Replaced by	A later claim replaced this one, and links to it
This claim replaces	This is the correction, and links to the original
This claim voids	This is the void, and links to the original
Secondary to, Tertiary to	Names and links the claim before this one and what its payer paid. A middle claim shows this and Balance billed to together
Crossed over by	The earlier payer forwarded this claim, or this payer paid it before ClaimPod sent it. Waits on this payer’s remittance or says what it paid
Balance billed to	On a primary: the balance went to the next payer’s claim, named and linked with its status
Took back the payment	An earlier payer took back the payment this claim was billed from. Void or replace it with its payer
Recouped after a refund	The payer recouped money after you had already refunded it. Names what it owes back and links the remittance. An overpayment letter covering it says Recovered twice instead
Behind the visit	A service behind a line was voided. Regenerate a Draft from the visit, revert a Ready claim first, or file a correction for a filed one
Lines awaiting the payer	The payer answered some lines but not others. Offers Open Remittances
Held remittances	The payer has responded, but the response is held for review. Review the remittance opens it
Filed but not delivered	The claim’s batch could not reach the clearinghouse. Retry delivery from the batch
Filed but not printed	The claim’s print batch could not reach its printer. Deliver it again from the batch or print it from the browser
This claim carries a credit	Money owed back to the patient or the payer, with its due date and Record Refund
An overpayment letter	The payer asks for money back, with Record Refund; then says it was refunded, recouped or recovered twice
Records sent	Records went to the payer, and when its response is due

States

• Not checked yet - on a Draft, the Findings tab says so until you run Check Claim.
• All findings resolved - on a Draft, says Check Claim will promote the claim to Ready.
• Passed review - a Ready claim is locked for export and read-only, until a rule, chart, coverage or visit change or an export refusal sends it back to Draft.
• Filed - on a filed claim, the Findings tab names the day it was filed and its batch; the findings stay as they were when it was filed.
• Voided - on a voided claim, the findings stay as they were when it was filed.
• No resolutions on this claim on the Resolutions tab.
• The claim no longer exists if it was deleted while you were away.
• Blocked - without the claims module the screen is not in the sidebar, and a saved link to it says the module is not part of your plan.

Related: Claims · Check and Fix a Claim · Export Ready Claims · The Claim Loop