Provider Central

Claims submitted through ConnectCenter

ConnectCenter provides you with many tools for tracking your claims. You can:

• Review your Worklists and the Claim Health Vitals on your home page for a bird’s eye view of claims you submitted in the last 30 days. Use the filters to reduce or increase the number of claims in this area. Learn more in our ConnectCenter Quick Start Guide.
• Use the Claim Search and Claim Status features to search for all claims matching your search criteria. Learn more in our Checking Claim Status Quick Tip.

EDI Claim Reports

If you or your clearinghouse submit claims as HIPAA-compliant 837 files, we recommend that you retrieve and review your:

• File Detail Summary Report (277CA Report)
• Batch and Claim Level Rejection Report (the “Submitter PDF report”)
  • The report will tell you the number of claims that were:
    • Submitted
    • Accepted
    • Rejected and why.
• Functional Acknowledgement (999 Report)
• Interchange Acknowledgement (TA1)

For more information on these reports, refer to our direct connection resource, 837 Transactions - Companion Guide for Health Care Claims.

Tips

• Retain all reports you receive from your electronic claim submission to track receivables and identify potential problems.
• Resubmit corrected claims electronically. Note: Do not use frequency code 7 for claims adjudication/resubmission of claims that were rejected on the EDI front end. You must resubmit this type of claim as a new-day claim, with claim frequency = 1 (CLM05-3).