Claims Dashboard provides detailed information on every claim generated in the system. The dashboard has a pie chart representation to get a quick view of the number of claims in the different statuses. Image 1 is a sample screenshot of the dashboard.

Image 1

The left pane shows the different buckets (that represent the various statuses) and the number of claims in the bucket as on the Claim date selected on the top of the dashboard. The default date range is 30 days before the current day. The different buckets in the dashboard are the following.

Out of these, the response buckets are Accepted, Clearinghouse Rejects, payer rejects and pending responses. These buckets have search filters for Claim Date, Patient and Insurance.

Buckets in the Claims Dashboard

1. Ready To Submit

Claims under this bucket are not yet submitted but are ready. ‘Ready’ in this context means that the charges are entered and verified to be sent. All claims initially fall in this bucket. Refer to Image 2.

Image 2

2. Unsubmitted Batches

Claims grouped into batches fall in this bucket. See Image 3.

Image 3

3. Error Batches

Batches found to be error-prone fall in this category. The system does the verification. Users can take corrective measures and batch them again to be submitted.

4. Accepted

Electronic claims for which the clearinghouse has okayed or the corresponding insurance has agreed to pay in full or partially, fall in this bucket. Refer to Image 4

Image 4

5. Clearing House Rejects

Electronic claims which have been rejected by the clearinghouses fall in this bucket. Click here to view a detailed discussion on typical clearinghouse rejections from Trizetto.

6. Payer Rejects

Claims rejected by the payer fall in this bucket. Rejections occur due to invalid data or missing information.

Note: For claims rejected by either the clearinghouse or payer, the rejection code is displayed in the rejection buckets and on the Claims History tab. Image 5 shows a part of the Claims History tab. The highlighted fields in the image are the clearinghouse rejection code and the payer rejection code.

Image 5

7. Pending Responses

The payer or the clearinghouse responds within the five days of claim submission. Claims for which no response has yet been received even after five days, fall in this bucket.

8. Downloaded

Electronic claims downloaded into the system can be viewed here.

9. New paper

Paper Claims that are ready (charges entered and verified) fall in this category.

10. Printed

This bucket contains paper claims already printed.

11. Hold

Lines in Hold status will appear under Hold Lines bucket. Lines in HOLD_Type sub status will be under separate buckets under the Hold category. Claims in these buckets will be excluded from batching and claim generation.

Further Filtering of Columns in Claims Listing

Every tab in the claims workbench has filtering at the column level wherein claim listing can be filtered further by – payer, clearinghouse, patient, claims status code, and others. All the fields are available for filtering except date fields, amounts, and number fields. Filter applied for status code with value ‘a1’ is illustrated in Image 6.

Image 6