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How to work insurance claims

With all the moving pieces of insurance claims, it can be tough to make sure no claims are forgotten. Follow this workflow to maximize your insurance accounts receivable.

Updated over 4 months ago

Step 1: Post ERAs

Post any open or pending ERAs and paper EOBs so you’re working with the most up-to-date information. Click here for more help on posting.

Step 2: Review Rejected or Denied Claims

  1. Search for any claims with a status of Rejected by Clearinghouse, Rejected by Payer, or Denied.

  2. If it’s a small issue that can be resolved quickly (e.g., adding a modifier), fix the claim and set it back to Ready to Bill.

  3. If it’s a longer-term issue (ex: authorization), move the claim to Hold. And add the items bellow:

1. Follow-up date

2. Note

Add helpful note to guide future decisions.

✅ Tip: If multiple claims are denied for the same patient, you only need to add a follow-up date and note to one of the claims. The Biller Dashboard will display the same follow-up info across all of that patient’s claims.

✅ Tip: Use the Bulk Update tool on the claims screen to update the status of multiple claims at once.

Step 3: Monitor Claims on Hold

  1. Go to your Biller Dashboard and click the HOLD status card.
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  2. This will show all claims currently on hold /being worked.

  3. If any claims do not have a follow-up date, click on the claim icon and set one. This ensures no claims are left behind.

Step 4: Follow Up on Claims

  1. In the Biller Dashboard, click on the Follow Up Today card to filter claims that need follow-up today or are past due.
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  2. If the claim is resolved → move it to Ready to Bill and resubmit.

  3. If it still requires action → leave a note and select a new future follow-up date.

Step 5: Missing ERAs

  1. In the dashboard, click the Missing ERAs card.
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  2. This filters any claims that were submitted 45+ days ago with no ERA posted.

5.1 Possible reasons

  • ERA received but not posted: Check for any unposted ERAs or paper EOBs.

  • Claim never received by payer: Call or log in to the payer portal. If they did not receive it, move the claim back to Ready to Bill and resubmit.

Step 6: Writing Off Claims

  1. Add an Insurance Write-Off transaction to the claim.

  2. Include a reason for the write-off.

  3. This ensures you can track how much your practice is writing off over time.

🚫 Moving a claim to Closed status does not remove the insurance balance. These claims will still appear on the Biller Dashboard.

Step 7: Sending to Collections

  1. Moving a claim to the In Collections status will remove it from your Biller Dashboard.

  2. This step should only be used once your practice decides to move the claim out of internal follow-up and into collections.

✅ End Goal: By following this workflow, you’ll make sure every claim is accounted for, nothing slips through, balances are accurate, and your Accounts Receivable stays under control.

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