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Insurance Billing 6: Managing Rejections

  1. Insurance Billing Training (US)
  2. Insurance Billing 6: Managing Rejections

    3. 5 min read
    Practice Plan Thrive Plan

This is lesson 6 of 9 in the US Insurance Billing training:

Billing Lesson Lesson Complete
Patient Insurance 🥳
Adding Billing Codes to a Visit 🥳
Managing Insurance and Patient Responsibility on a Visit 🥳
Claim Submission Folders 🥳
Claim Submission 🥳
Managing Rejections ✍️
Posting Insurer Responses ☐
Resubmissions ☐
Accounts Receivable ☐

If the clearinghouse or insurer rejected a claim, you’ll likely need to make changes to the claim and resubmit.

Rejections vs. denials

  • Rejection: The clearinghouse (before the claim reached the insurer) or the insurer’s front end (before adjudication) found an issue and stopped the claim. Fix: Correct the claim and resubmit it as an Original Claim.

  • Denial: The insurer processed the claim, then denied all or part of it. The insurer response includes a claim control number and a denial reason. Fix: Submit a Replacement Claim or appeal, based on the insurer’s guidelines. Check out our guide on Resubmissions.

Step 1: Understand the rejection

With the Claim.MD integration

Jane automatically moves rejected claims to the Rejected folder. To see the rejection reason:

  1. Select View next to the claim.
  2. Go to Submissions & Acknowledgements.
  3. Click the red rejection notice.

The Claim Summary panel for a claim in the Rejected folder, with the red rejection notice expanded under Submissions & Acknowledgements showing the reason “Missing or invalid information.

Without the Claim.MD integration

Find the rejection reasons in your clearinghouse.

Step 2: Correct the claim

The correction depends on the rejection reason. Common fixes include:

  • Editing the patient’s policy information under Patient > Billing > Insurance Policies.
  • Adjusting the billing codes on the patient’s visit.

If the patient paid their patient responsibility at the time of service, click Update Invoices after changing the invoice so the resubmission reflects your changes.

đŸ©µ Jane Tip: If you use the Claim.MD integration, make your corrections in Jane to keep your claim submission history accurate.

The Insurance section of a visit with the Allow Editing toggle turned on and the Update Invoices button below the message “Changes have been made since invoices were last upd

Step 3: Move the claim back to the Draft or Unsubmitted folder

You can only submit claims from the Draft or Unsubmitted folders. To move a claim from a Claim Submission folder, like Submitted or Rejected:

  1. Select View next to the claim.
  2. Use the circle drop-down at the top of the Claim Summary panel.
  3. Select Mark as Draft or Mark as Unsubmitted.

The Claim Summary panel with the circle drop-down open next to Claim, showing the Mark as Draft and Mark as Unsubmitted options.

Step 4: Resubmit the claim

  • With the Claim.MD integration: Select Submit.
  • Without the Claim.MD integration: Upload the new electronic submission to your clearinghouse.

Continue to Insurance Billing 7: Posting Insurer Responses

đŸ“˜ Continue learning the insurance billing workflow in Insurance Billing 7: Posting Insurer Responses