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Insurance Pending Claims

The Insurance Pending Claims page allows providers to see all of their pending insurance claims, as well as move claims to their Insurance Claims Needing Attention page or resubmit them.

To access the Insurance Pending Claims page, click "Claiming" in the menu, then click "Insurance," then click "Pending Claims."

Providers can use the filters on the Insurance Pending Claims screen to pull up the information they are looking for.  Providers can use the drop-down menu to select an insurance company, enter a date range to pull up specific service dates, and/or enter a child's last name to pull up claims for a specific child.

Once any filters have been entered, click "Retrieve" to pull the claims up on the screen.

Claims will be listed with the child's name, authorization number, date of service, amount billed, CPT code, status of the claim, and the child's insurance policy number.

If a provider needs to resubmit claims to an insurance company, you can simply select the box next to the claim(s) then click "Resubmit"  at the bottom of the screen.

The "Resubmit" button will resubmit claims to an insurance company.  This would be necessary if the child's insurance policy information has been updated or if the provider's address has been changed.  If a provider has received an EOB that suggests that a claim should be resubmitted, they should now use this page to resubmit the claim, rather than entering the EOB with the denial reason "Resubmit" on the Reporting EOB's page.

If a claim needs to be edited before it is resubmitted, providers can click "Edit/Fix Claim" next to the claim to access the "Fix Insurance Claim" screen.  This is the same editing screen that is linked from the Workable Claims pages. 

Please note that claims should only be resubmitted after corrected information is reflected on - this means waiting for the next NYEIS data import or for a KIDS insurance batch upload to be uploaded and processed.

Article ID: 104, Created On: 7/31/2013, Modified: 10/28/2015

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