Claim Actions

Learn more about the kinds of insurance claims actions you can make in Zencare!

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 and select a claim's checkbox. Once selected, the actions panel will appear.

Create Claim

For more details on creating claims, see the Creating and Submitting Insurance Claims article for a full breakdown.

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, Rejected, Corrected, and Denied Claims.

Update/Resubmit Rejected Claims

For Claims that have been Rejected by a Clearinghouse, you have the option to Update Claim and Resubmit from the Actions panel after reviewing Rejection reasons. Follow the Update Claim prompts to fix any rejection reasons and resubmit the claim.

Create Replacement

You can create a replacement for a denied claim that has been voided. This new claim will be populated with the information from the original claim so you can easily make the needed adjustments.

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.

You can download, print, or email the EOB from the left hand side of this view. In the Email drop down menu, you can select and add recipients, as well as an attached message, and even add a password to the generated PDF for added security.

User Actions by Claim Status

The following is a table of actions you can take depending on the current claim status. Check marks denote that an action can be taken under the given claims status, and X marks denote that an action cannot be taken under said status.

Authorization Checkboxes

Note that many claims actions require you to select the authoriztion checkboxes before proceeding with the action. Unless you select these checkboxes, the desired action will be grayed out and you will not be able to proceed.