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Getting Started with the Claims Page

The Claims Page is where you’ll spend most of your time managing your claim workflow. It’s designed to help you work faster with fewer errors by giving you powerful tools for filtering, reviewing, and submitting claims. Here’s what you’ll learn:

• How to find the claims you need to work on
• How to review and fix claims quickly
• How to submit claims with confidence
• How to work with your team

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Find What You Need to Work On

The Claims Page shows you all encounters in your system. With thousands of claims, the key is filtering down to exactly what you need right now.

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Use filters to focus your work

Click Filter at the top of the page to narrow down your list. You can filter by:

• Encounter Status - Draft, Ready for Review, Approved, Submitted, Denied
• Assignment - Claims assigned to you, others, or unassigned
• Insurance Provider - Specific payers
• Claim Amount - Dollar value ranges
• Age - How long the claim has been in the system
• Date Ranges - Creation, submission, or payment dates

Combine multiple filters to get exactly what you need. For example: “Show me all Blue Cross claims over $500 that are ready for review.”

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Save views for quick access

Once you’ve set up filters you use regularly, save them as views.

1. Apply your filters and column settings
2. Click Save View in the top right
3. Give it a descriptive name like “My High Value BCBS Claims”

Your saved views appear in the Views dropdown and persist across sessions. Each team member creates their own views based on how they work. Common views to start with:

• Filter for claims assigned to you + status “Ready for Review” or “Approved”
• Filter for unassigned claims to pick up new work
• Filter for recent denials to work through corrections

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Assign claims to track ownership

Every claim should have an owner. This prevents duplicate work and ensures nothing falls through the cracks. To assign a claim to yourself:

1. Find the claim in your list
2. Click the Assigned To dropdown
3. Select your name

The claim now appears in any “assigned to you” filtered views you’ve created. To assign multiple claims at once:

1. Select the checkboxes next to multiple claims (or click the header checkbox to select all visible)
2. Click Bulk Actions
3. Choose Assign and select the team member

This is useful for distributing work across your team or picking up batches of unassigned claims.

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Review and Fix Claims

When you’re ready to work on a claim, click it to open the encounter details. Most of your work happens on the Content tab.

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What to check on every claim

Before submitting, verify:

• Patient demographics - Name, DOB, address, insurance details
• Date of service - Correct and matches documentation
• Provider information - Correct provider and facility NPI
• Diagnosis codes - Support the procedures billed
• Procedure codes - Match services provided
• Units and charges - Accurate for the services

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Let AI help you catch errors

The system automatically validates every claim and helps you fix issues before submission. Sparkles (✨) show where AI improved your claim When you see sparkles next to a field, AI made a change to maximize reimbursement or ensure compliance. Common improvements:

• Corrected zip codes or addresses
• Added required modifiers to procedure codes
• Updated place of service codes
• Suggested better-matching diagnosis codes

Click the sparkle to see what changed and why. Accept if it makes sense, reject if it doesn’t apply to this case. Error flags show what needs fixing Red or yellow flags indicate problems that will cause rejections:

• Missing required fields (DOB, insurance ID, provider NPI)
• Invalid diagnosis or procedure codes
• Conflicting information

Fix these immediately. The claim can’t be submitted until all flags are resolved. Blocking rules prevent bad submissions If a critical issue will definitely cause denial, the system blocks submission entirely:

• Missing required information in critical fields
• CHC compliance violations (for federally qualified health centers)
• Known payer rejection patterns based on historical data
• Internal rules your organization has configured

You’ll see a clear error message explaining what needs fixing. If you can’t fix it immediately, assign it to someone who can.

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Preview before submitting

Click Preview to see exactly what will be sent to the payer. You can view it in standard format or PDF. This is your last chance to catch any issues before the claim goes out. On the Submissions tab, you’ll see “X rules applied” showing which billing rules were automatically applied to optimize your claim. Click to review the logic behind each rule.

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Get help when you need it

Ask the AI Copilot Click the AI Copilot button to ask questions about the claim. Examples:

• “Why would this diagnosis code be rejected?”
• “What’s the correct way to code this for Blue Cross?”
• “Does this procedure require a modifier?”

The copilot understands the claim context and provides guidance on coding guidelines and payer rules. Collaborate with your team Some claims need input from others. Use the Activity section to:

• See all recent changes and who made them
• Add comments and @mention specific team members
• Reply to questions and document decisions

All communication stays with the claim, so context doesn’t get lost.

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Submit with Confidence

Once you’ve fixed all errors, reviewed AI changes, and previewed the claim, you’re ready to submit.

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Submit the claim

1. Click Submit at the top of the encounter details page
2. Review the confirmation dialog (payer, amount, procedures)
3. Click Confirm Submission

You’ll see “Claim successfully submitted” and the status updates to Submitted. What happens next:

• 1-3 days - Payer acknowledges receipt
• 14-30 days - Payer processes the claim
• 30-45 days - You receive payment or denial

Return to your Claims Page and move to the next claim in your queue.

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Handle Denials

Denials happen. When they do, your goal is to understand why, fix the issue, and resubmit quickly.

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Find your denials

Filter by Status: Denied to see all rejected claims. Sort by:

• Claim amount (highest first) - Tackle high-dollar denials first
• Denial date (oldest first) - Avoid timely filing limits
• Payer - Spot patterns in rejection reasons

If you see the same denial reason across multiple claims from one payer, flag this pattern to your team lead.

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Fix and resubmit

1. Open the denied claim
2. Go to Payment Overview to see the denial code and reason
3. Check Remittances for the full ERA with additional details
4. Make corrections based on the denial reason
5. Document your changes in the Activity Feed
6. Resubmit following the same process

Common denial reasons and fixes:

• Missing/invalid information - Add missing demographics, insurance details, or authorization numbers
• Coding errors - Correct diagnosis or procedure codes, add required modifiers
• Duplicate claim - Verify if already paid or add note explaining it’s not a duplicate
• Medical necessity - Add documentation or escalate to provider
• Timely filing - Document original submission date if submitted on time

Note: Timely filing deadlines are strict (typically 60-90 days from date of service). If you’re approaching the deadline, prioritize that claim immediately.

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Understanding Claim Statuses

As claims move through your workflow, they’ll have different statuses:

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Common Questions

Which claims should I work on first?

Prioritize in this order:

1. High-value claims nearing timely filing deadlines - Sort by claim amount and age
2. Claims from your top payers - Where most of your revenue comes from
3. Recent denials - Still have time to correct and resubmit
4. Older claims (10+ days) - Prevent aging out

Create saved views for each priority level and switch between them as you work.

What if AI suggests something I know is wrong?

This happens. AI uses general rules but you have payer-specific knowledge.

1. Click the sparkle and select Reject
2. Make the correct change manually
3. Add a comment explaining why: “Rejected AI suggestion. This payer requires modifier XU per their 2024 policy.”

If you see AI consistently wrong for a specific payer, report it to your team lead. Good billers reject 5-10% of AI suggestions based on their expertise.

Should I submit claims with error flags?

No. Error flags indicate problems that will likely cause denials.Fix all flags before submission. The extra 2-3 minutes now saves 20-30 minutes of denial rework later. If you can’t fix a flag, assign the claim to someone who can.

How do I collaborate with my team on a claim?

Use the Activity section within the encounter details:

• Add comments to ask questions or flag issues
• @mention specific team members to notify them
• Review the change history to see what others have done

All communication stays with the claim so context doesn’t get lost.

Can I customize what columns I see?

Yes. Click the Columns button at the top of the Claims Page to choose which fields to display. Your column preferences save with your custom views.Common column setups:

• For submission work: Patient, DOS, Provider, Amount, Status, Assigned To
• For denials: Patient, Payer, Denial Reason, Denial Date, Amount

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That’s it. You now know how to find claims, review them efficiently, submit with confidence, and handle denials. Start by creating your first saved view and working through a few claims to get comfortable with the workflow.