A Claim Will Not Move

The Claim Will Not Reach Ready

Ready is earned by passing the review rules, so a claim stays in Draft while any finding is unresolved.

Fix: open the claim, select Check Claim, and clear each finding on the field it names. Two clear from their row on the Findings tab instead: Filing Deadline Passed with Record Delay Reason…, which needs a Manager or Administrator, and Provider Not Enrolled with Add Enrollment…. Check and Fix a Claim walks it.

If the same finding returns on claim after claim, the fault is in a source record rather than the claims. Correct the provider, location or patient once instead.

“No claims are ready to export”

There is nothing in Ready to collect. Draft claims are not eligible, however finished they look.

Fix: check and clear the draft claims first.

“Configure EDI Settings first”

Electronic claims need the client’s EDI settings, because ClaimPod will not produce a claim file it cannot address correctly. What you see depends on what is Ready.

• Only electronic claims are Ready: Create Claim Batch is greyed and says to configure EDI settings first.
• Paper claims are Ready too: the export runs. The dialog says that 837P needs EDI Settings and that the electronic claims stay Ready until they are configured; the print batch is made and the electronic claims wait.

Fix: an administrator sets these on the client’s EDI tab. The waiting claims go into the next export.

An Export Sent a Claim Back to Draft

The export checked the claim again as it built the file and left it out. Common reasons are a billing address that is a PO Box, an incomplete pay-to address, a missing billing NPI, a hospital place of service (21 or 23) with no hospital service location, or a voided service behind a line.

Fix: open the claim. The reasons are in Findings, and the claim waits in Claim Review. Correct the source record or the claim, check it, and export it again.

Some Claims Were Not Batched

The export toast reads “Export started” and then how many claims were not batched. One format’s batch could not be made, so those claims were never filed. The other format’s batch was made as usual.

Fix: read the reason in the toast. The claims are still Ready and go into the next export once it is fixed.

The Claim Was Rejected

A 277CA, 999 or TA1 refused the claim before the payer adjudicated it. The claim reads Rejected and waits in Follow-up Claims; when the clearinghouse rejected the whole file, every claim in it is Rejected.

Fix: open the claim’s Acknowledgments tab to read what was refused, and correct it on the patient, coverage, provider or location record. Then select Resend Claim, or Resend Rejected Claims on the batch for the whole file. Both need a Manager or Administrator.

The Claim Reads Not Delivered or Not Printed

The claim is filed, but its batch could not reach the clearinghouse or the printer. The batch reads Transmit Failed or Print Failed.

Fix: open the batch and deliver it again from Deliveries. A paper batch can also be printed from the browser with Download PDF.

The Batch Says Test Mode

The batch was generated for testing. It is a real file, and it must not be submitted for payment.

Fix: none needed, but do not send it. Produce a live batch once the client is configured for real submission.

A Claim Was Filed With the Wrong Data

Batches never change after the fact, which is deliberate: the filing history stays honest about what was sent and when.

A filed claim cannot be edited either, so the correction goes out as a new filing.

Fix: use Replace & Refile on the claim to send a frequency 7 correction once the payer’s claim number has arrived. For a claim the payer never answered, or one that was rejected, use Resend Claim. For a claim billed to the wrong coverage, use Rebill to Another Payer. Do not expect the old batch to update.

Related: Export Ready Claims · Claims