🔂 How to Modify and Resubmit a Single Claim

There are dozens of reasons why a claim may be rejected or denied and require resubmission—an incorrect CPT code, new insurance information, a typo anywhere, etc. This guide shows how to fix errors in a claim and resubmit it so that your practice can get paid.

First, go to the Claim Details page and find the claim you would like to edit and resubmit.

Use the filters to expedite the search process. You can look up claims by anything from Primary Claim Status to the patient’s name to the individual claim number.

Next, choose the claim you want to resubmit.

Click on the ‘Actions’ menu and select Modify and Resubmit.

From here, you will be able to edit a huge amount of information in the claim. We’ll take a look at the possibilities in the order they’ll appear on your screen.

At the top of the editing window, you will find the option to Regenerate a claim. Clicking this will reset the information in the claim to its original state at the time of submission. This is particularly useful if changes were made incorrectly, or if some unknown piece of information is now missing.

You will also see the Save and Resubmit Claim button. This is where you’ll go after you’ve changed everything you would like.

This section will tell you where to look for errors in the claim. In this example, check for prior authorization issues as well as coding issues.

Athelas defaults to Electronic delivery. However, you can opt for Manual delivery instead, and then choose Mail, Email, or Fax, then fill in the corresponding information.

The patient’s information will be pre-filled, and you can edit any typos if necessary.

If you need to update policy holder information, you can choose the patient’s relationship to the policy holder at the top and then fill in the required information in the corresponding section below, as seen in this example.

Athelas defaults to the ‘Not Required’ option for supporting documentation.

If documentation is required, choose the ‘Required’ option and then attach the corresponding files.

Once you choose which kind of cover letter you would like to send, it will be auto-generated. a ‘Preview’ button will appear next to the Cover Letter menu. Click it to see the cover letter.

By default, cover letters and any attached documents will be sent automatically with the claim resubmission. If you would like to send attached documents on their own, simply click ‘Manually Send Now.’

You also have the option to ‘Preview CMS1500 Form’ that is sent along with documentation.

To add a diagnosis code, click the ‘+ Diagnosis Code’ box and enter the code. You can delete a diagnosis code by clicking the trash icon.

The same process applies to service lines. You can edit individual service lines by clicking the corresponding pencil icon.

When you click + Service Line a popup will appear. Fill out the information and then click Create Service Line. Your new entry will then appear in the list of service lines.

The rest of the sections in this view are straightforward data entry, and they are prime candidates for typos. Be sure to double check these sections for human error:

📢 We’re here to help! Please contact your account manager if you would like some hands-on assistance.