Monitor claim status from your Client’s Profile. Review detailed transaction history, manage, void, edit, and resubmit claims effortlessly!
View a Client's Claims
Step 1: Log in to Zencare Practice Management
- access your Zencare Practice Management account using your credentials.
Step 2: Navigating to Client Claims
- Once logged in, navigate to the Clients section.
- In the Clients section, select and open the client profile you are adding coverage for.
- Within the client profile, click on the Insurance section.
- Within Insurance, navigate to the Claims tab.
Step 3: Review All Submitted Claims
- From the Claims tab, you will see all claims that have been submitted for the selected client, their status, as well as additional actions you can take from this screen per claim.
- Filter this view as desired by the below options:
View All Clinic Claims
Step 1: Log in to Zencare Practice Management
- access your Zencare Practice Management account using your credentials.
Step 2: Navigating to Practice Workflow Claims
- Once logged in, navigate to the Workflow section.
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Under the left navigation bar section titled 'Insurance' you have the option to view all claims (that your permission level grants) by those that are Unadjudicated (processing) or those that are Adjudicated (fully processed)
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To learn more about Workflow Unadjudicated and Adjudicated features, see the following articles:
Claim Status
- Queued: claim has been submitted by the user from the Zencare Practice Management application and has been queued for submission to the claim clearinghouse.
- Submitted: The claim has been submitted to the clearinghouse for audit and submission to the insurance payer.
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Rejected: The claim has been submitted to the clearinghouse, audited, and did not pass the audit. The claim has not been submitted to the insurance payer and have been returned to the user in Zencare Practice Management with rejection reasons.
- If you receive a Rejected claim, to view the rejected reasons hover your mouse over the 'Rejected' status in the Claims table. All Rejected reasons will be displayed here.
- Voided: The claim has been Voided by the Zencare Practice Management User for any reason at any point in the Claim processing cycle.
- Paid: The claim has been submitted to the clearinghouse, passed the clearinghouse audit, submitted to the insurance payer, adjudicated as approved by the insurance payer, and ERA returned. The actual insurance payment is processed outside Zencare Practice Management, directly from the payer to the provider.
- Denied: The claim has been submitted to the clearinghouse, passed the clearinghouse audit, submitted to the insurance payer, and adjudicated as Denied by the payer. Denials can be for any number of reasons deemed by the insurance payers plan.
Claim Actions
Claim actions are currently only available at the individual claim basis. To take one of the below available actions: navigate to the Client's Claims screen or the Workflow Insurance screens mentioned above and select a Claim's checkbox. Once selected, the actions panel will appear.
- View Details: For all Claim statuses, select the View Details action to open the review claim screen. Use this to reference the sessions and other billing codes submitted for a specific claim.
- Void Claim: For any reason a user decides voiding a claim is necessary, this can be done by selecting the Void Claim action. This is available for Queued, Submitted, Rejected, and Paid Claims.
- Edit/Resubmit Rejected Claims: For Claims that have been Rejected by a Clearinghouse, you have the option to Edit Claim and Resubmit from the Actions panel after reviewing Rejection reasons.
- Follow the Edit Claim prompts to fix any rejection reasons and resubmit the claim.
- View Paid Claim Explanation of Benefits (EOB): For Adjudicated and Approved Claims, you can select the action to View EOB. This feature allows you to view the service details and review the Amount Billed for a service, the Insurance Adjustment amount, the Amount Paid by Insurance, as well as the Client's responsibility Amount.
