Claims On Hold Overview

Claims that sit in the On Hold category in the Claims tab require work before they can continue to be processed in the system. These claims stay On Hold until something is done with them. A couple reasons a claim could be on hold:

  • You received an insurance denial.
  • You wrote off too much on the claim.
  • The claim was overpaid.
  • The system does not know how to allocate all the money when posting an insurance payment.

Two ways to access claims that need to be worked

Option 1:

  1. Log in to Insight Billing.
  2. From the Claims tab, select the On Hold category.
  3. Double click any claim to open the Claim Editor.
  4. Once the Claim Editor opens, use the scroll bar to navigate to the Hint column to help you determine what you need to do with the claim.

Option 2:

  1. Log in to Insight Billing or EMR.
  2. From the Reports tab, select Claims on Hold from the Claims Research branch of the reporting tree.
  3. Once the report opens, drag the Hint column header to the gray "Drag a column header here to group by that column" section.

  1. Select the + sign next to each denial reason to see the list of claims that have that denial. Claim numbers are in blue hyperlinks that you can use to go open the claim directly in the Claim Editor.

Specific steps you need to take to rework the claim depends on what needs to happen to the claim. Refer to the list below for specific examples.

Claims Rework Due to Treatment or Diagnosis Code Changes

Claims Rework Due to Maximum Benefit Reached Denial

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