How to Resubmit or Cancel a Claim

Related Training

Managing Insurance Claims Recorded Class

Sensei Cloud enables you to easily resubmit claims when claim information needs to be updated or in instances where a claim has not been received by the insurance company (e.g., claim lost in the mail) and you simply want to resend the claim with all of the existing information staying the same. 

You can make the necessary changes to the claim information (e.g., patient demographics, insurance company address, etc.) and resubmit the claim with the click of one button. The Resubmit Claim option is available from the Claim Summary within the Claims Management screen, which can be accessed from either the Patient or Location tab. 

Sensei Cloud also enables you to cancel claims as needed. See Cancelling a Claim for more information.

Resubmitting a Claim

You have the option to quickly and easily resubmit claims without the need to cancel the original claim submission. This resubmission process ensures that the claim submission history information is maintained. 

The following procedure allows you to fully resubmit existing claims that have already been Queued for submission, Submitted to the clearinghouse, or have reached a post-Submitted status through manual status updates or as a result of taking actions (e.g., such as posting an insurance payment against a claim).

To resubmit a claim:

1. If applicable, update the claim information that needs to be changed (e.g., Patient Date of Birth, Patient ID Number, Insurance Company information, etc.).
2. From the Patient tab, click Insurance > Claims Management or navigate to the location's Claims Management list (Location > Claims > Claims Management).
3. Click on the claim line item to expand the details. The Claim Summary is displayed.
4. Click Resubmit Claim. 
   The status of the original claim changes to Resubmitted, and the Status Change Note updates to Resubmitted as Claim #[Claim Number]. 
   The updated, replacement claim has been created and is either automatically Queued for submission or is ready for final review and submission (depending on your claim handling settings). You can navigate to the replacement claim by locating the new claim number (as indicated in the Status Change Note of the original claim) in the Claims Management list. 
   Note:
   -- The replacement claim inherits all of the current claim data, including the history, supplemental information (e.g., additional info), pre-auth reference numbers, and any electronic claim attachments. 
   -- The new claim also reflects any updated information to the underlying records that may have changed since the original submission, such as edits to the patient or policyholder demographics, policy information, or updated anatomy information for the billed charges.
   -- If applicable, you can make any further edits to the claim (e.g., edit additional info, update the location or provider, etc.), and then submit it. 

Cancelling a Claim

In cases where you need to cancel a claim altogether, this can be done from the following locations in the software:

• Location Tab > Claims > Claims Management
• All Locations Tab > Claims > Claims Management
• Patient Tab > Insurance > Claims Management
• Patient Tab > Financials > Ledger

Important: This procedure does NOT apply to Continuation of Treatment (COT) claims. See How to Cancel and Resubmit Continuation of Treatment Claims for more information. 

Claims Management Screen

To cancel a claim:

1. From the Patient tab, select Insurance > Claims Management.
2. Click on the claim line to expand the summary.
   
3. Click Cancel Claim. You are prompted to confirm the action.
   
4. Click Yes. The claim is canceled, and the procedures are added to the unbilled procedures list.

To resubmit a claim after cancelling:

1. Under Actions, select Create New Claim. The Create Insurance Claim window is displayed, containing a list of the patient's unbilled procedures.
   
2. Select the procedure(s) you want to include in the claim.
3. For Insurance to Bill, if there is more than one plan for the patient, you can select which plan to bill.
4. Click Create.

Patient Ledger

When a posted procedure is adjusted or removed, you are prompted to cancel the associated claim and create a new one with the updated details.  

1. From the Patient tab, select Financials > Ledger.
2. Select the ledger entry to expand the details. The claim number associated with the charge is displayed.
3. Select Adjust This Charge.
4. Click on the procedure to expand it, and select Adjust this Charge on the far right of the procedure line. The Adjust this Charge window is displayed.
   Note: For more information, see How to Adjust or Remove Charges on the Patient Ledger.
5. Select either Remove Entry or Correct Information and make the changes.
6. Use the Adjustment Comments field to enter a comment or reason for the adjustment.
7. Click Adjust Charge. You are prompted to confirm the action.
   
8. Select Yes, Adjust Charge and Cancel Claims. The claim is canceled, and the Create Insurance Claim window is displayed, prompting you to re-create the claim with the adjusted information.
9. Click Create.
    

Adding Additional Information

When you cancel and create a new claim, you can use the Edit Addl Info button on the Claim Summary area to add remarks or details needed for the re-created claim.