Dealing with Rejected Claims

Dealing with Rejected Claims

From time to time electronic claims will be rejected. In this case they will appear on the Rejected Claims tab on the ECLIPSE page.  The Invoice Status will also get changed to Follow Up, so you can easily locate rejected claims on the Follow Up tab in the Invoices listing page. Here are some tips to assist you in resolving these.
 
  1. On the Rejected Claims listing the Process Status column will tell you if it's been rejected by Medicare or the Fund
  2. The two right hand columns may have error codes - hover the cursor over to see what the code means
  3. Now go to the invoice by clicking on the arrow (triangle button) at the left of the listed item
  4. The History tab on the invoice will have more details about the rejection. Check if the whole claim was rejected or only certain items.
  5. Check the knowledgebase for more information on common rejection codes.
A claim may be rejected because of the following:
 
  1. Medicare or Fund details are incorrect - to avoid this error, you should always verify before submitting an invoice.
  2. The claim has already been paid.
  3. The patient has a waiting period or exclusion
  4. Other reasons

To resubmit a claim:
 
  1. If the entire claim was rejected, it is safe to resubmit the same invoice after you've rectified the problem. Change the Invoice Status to Queued, then click Submit Now. You may get a warning - this only acts as a reminder not to submit a second claim while the previous claim is still being processed.
  2. If only some items were rejected, the invoice can't be resubmitted, it's better to create a new invoice with only those items and submit that. For neatness, you can remove the rejected items from the initial invoice and change its status to Fully Paid.
  3. Once a claim has been resubmitted it's best to remove it from the Rejected Claims list (click X at the right hand end of the line) so you only have a list of claims requiring attention.
  4. Sometimes rejections can't be sorted out electronically, and in this case you'll have to contact the fund by phone or post.

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