Claim Issue Listing Overview

The Claim Issue Listing report provides a list of all claims at Not Ready status, i.e. claims that are missing information that is required to bill successfully. Issues that appear on the list can usually be corrected in one of two ways, double clicking on the issue to open the Claim Editor or using the one of the editors (Client, Staff, or Payer) to enter the missing information. Once the issue is corrected, it falls off of the Claim Issues Listing. Each time you run the claim issue listing, the list is refreshed and any items that have been corrected are cleared.

How Do I Access The Claim Issue Listing?

You can access the Claim Issue Listing in one of two ways:

  • If you are using Insight EMR, use the icon or use the Run menu and select Claim Issue Listing.
  • If you are using Insight Billing, use the Run menu and select Claim Issue Listing.

How Often Should I Use It?

The Claim Issue Listing should be run daily to find missing information that prevents a clean claim from being sent. You can manage the information on the list using the following buttons, which are located along the bottom of the window:

  • Close - Closes the window and returns you to the tab you were previously on.
  • Preview - Opens the Print Preview window.
  • Print - Sends the issue list directly to the printer.
  • Excel - Opens the Save As dialog box so you can save the issue list as an Excel file.
  • Edit Claim - Opens the Claim Editor for the claim you have selected.
  • Refresh - Updates claim issue listing. Any items that have been corrected drops off of the list.
  • Task - Opens the Create New Task window so you can create and assign a task to the staff member responsible who needs to provide information for the claim.

Filter information using a drop down arrow on any column, selecting the column header and dragging it to the gray area, or using a custom filter.

What issues appear on the Claim Issues Listing?

The table below briefly describes the types of alerts that are flagged in the Clinical Issues List. Click on the issue type below to learn more.

Issue Type Where You Need to Go to Fix it
Referring Physician NPI for <name> is blank. NPI # field on the Edit Contacts dialog. Refer to Enter Referral Contact Information.
NPI # field on the Edit Contacts window. Refer to Enter Referral Contact Information. Add P.O.C. button on the Case Information tab of the Client Editor.
No authorizations as required by payer <name>.

Add button (Insurance Authorizations section) on the Case Information tab of the Client Editor dialog.

or

If no authorization is required, remove the requirement (Edit > Payers > General Billing Data tab. Clear the Authorization Required check box).

No authorization number to print as required by payer <name>.

Add button (Insurance Authorizations section) on the Case Information tab of the Client Editor dialog.

or

If no authorization is required, remove the requirement (Edit > Payers > General Billing Data tab. Clear the Print Authorization Number check box).

Primary payer signature for Block 31 is blank. <name> is missing Signature Line. Verifying the Signature Line is completed (Edit > Staff and review the signature line). Refer to Add Staff Members.
Secondary payer subscriber Member ID, Policy # or Claim # must be entered. Open the Client Editor dialog, select the Case Information tab and add the missing ID, Policy #, or Claim # to the Secondary Payer tab.
<name> is not credentialed with <payer name>. Payer Credentialing section of the Edit Staff dialog. Refer to Insurance Credentialing Setup.
<name> does not have credential number for <payer name>. Provider # field (Payer Credentialing section) of the Edit Staff dialog. Refer to Insurance Credentialing Setup.
Case: <case description> does not have a valid Plan of Care for Claim with Start Date of <date>. Add a new Plan of Care or edit the effective date of the existing one (Client Editor > Case Information tab). Refer to Case Information Tab Overview.
Therapist: <name> is missing NPI #. NPI # field on the Edit Staff window. Refer to Add Staff Members.
Primary payer subscriber Member ID, Policy # or Claim # must be entered. Add the member ID, policy #, or claim # to the Primary Payer tab in the Case Information tab of the Client Editor dialog.
Primary payer: <payer name> has no EDI Payer ID. EDI Payer ID field on the Edit Payer dialog (Edit > Payers > General Billing Data tab). Refer to General Billing Data Tab to learn more.
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