Claim Rejections

Claim Rejections are claims that are sent to the payer, but the payer returns them before entering into their system. Each payer "scrubs" files they receive for matching information in their system before they accept the files. 

For example, if you submit a claim for Jon Doe with DOB 1/1/1990, but in the payer's system, they have John Doe with DOB 1/1/1990; they may reject the claim for Member not Found or Member not on File.

A few other things to note: 

1. Rejection reasons listed in Checkpoint are directly from the payer.
2. Often the Claims Department at the payer will not see rejected claims and might say they do not have the claims on file. 
3. The EDI Department at the payer handles all claim rejections.

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How to view and work the Claim Rejection section in CP. 

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1. Log in to https://www.checkpointehr.com

2. Select the Billing menu -> Billing-> Claim Rejections

3. By default, you will be presented with the "Unresolved; needs attention" rejections. These are new rejections that have not been addressed.

4. Checkpoint will present when the claim was submitted, the client and dates of service affected, and the error from the payer.

***Only one date of service per claim will be displayed. Claims can have multiple day of service. It is best practice to look at all the dates of service submitted on that day.

5. When working Claim Rejections, you can use the pencil icon to add comments to the line item. Click on the pencil to add a comment.

6. Add text in the "Comments" box.

7. Click "Save" when finished.

8. Once the necessary corrections have been made and the claims resubmitted, you will want to move the rejection from the "Unresolved; needs attention" category. To do this, click on the edit icon (pencil).

*** You cannot resubmit claims from the Claim Rejection page. You must change the session status in the client profile to billing ready or create a manual batch in order for the claim to be submitted.

9. From the "Status" dropdown select an appropriate category.

10. For this example, we are selecting "Resolved; resubmitted".

11. Make sure to click "Save" once the category has been chosen.

12. When moving multiple items to other categories, the easiest method is to check the box of the items you wish to move, pick a different category at the top under "Change selected to:" and then select "Update Selected".

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