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Resubmit a rejected claim

Resubmit a patient claim that's bounced back with an error or is 'PENDABLE'

Updated over a week ago

Sometimes Medicare can reject your transmitted patient claims for not containing certain information they require in order to process the claim. Rather than deleting the invoice altogether, you can easily edit the invoice accordingly to meet Medicare's requirements to then resubmit the claim.

This article includes:

Resubmitting a rejected claim

1. From your client's file, click Invoicing 

2. Hover your mouse cursor over Actions and click Edit

3. Scroll down to the bottom, set Send request now to Yes and click Update Invoice

4. After resubmitting the claim, you should then see the assignment advice

💡 Prior to resubmitting the claim, the invoice will need to be unlocked

💡 You can view the history of past resubmissions via Actions > PCI

Resubmitting a PENDABLE claim

1. From the client's file, go to Invoicing

2. Hover your mouse cursor over Actions and click PCI

3. Click on Resubmit.

If the status of the claim is PENDABLE (or MEDICARE_PENDABLE) it is indicating further action and resubmission are required.

The PENDABLE status could be applied for several reasons, such as

  • Service text is required for a standard item number, for example, ‘Not normal aftercare’

  • Item numbers and duplicate items that require additional service text information, such as reasons for Multiple procedure overrides

  • An individual item deemed assessable prior to approval, for example, some diagnostic imaging and pathology items.

  • Any supplemental information with the potential to require manual assessment can return as PENDABLE

While a claim is PENDABLE, it has not yet been received for manual assessment by Medicare.

Resubmitting the claim to Medicare will update the status to PENDED and it will be manually assessed by an operator.

🛑 Medicare has a one-hour window for this to be resubmitted, so please action right away.

🛑 If done in the first hour you can select " send request now to" > "no" > update invoice. Then select "send request now" to "yes" and then select "update". This will change the status from Pended to Pendable.

If not actioned within this window, a new claim has to be created.

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