The Failed by Apex tab displays any claim that encounters an error during the import process. This typically happens when something is missing from the claim, or when Apex is unable to recognize required information. You can use the Failed by Apex tab to locate and correct your claims so they can be sent to the payer.
NOTE: Claims that are Failed by Apex are not the same as Rejected Claims, which come directly from the insurance company's EDI department or clearinghouse.
Find a Failed Claim
Apex will notify you any time you have a failed claim. A red number on the Failed Claims tab indicates the total number of failed claims that require corrections.
- Click on the Failed by Apex tab.
NOTE: The All Claims tab also displays failed claim alerts. A red number in the Failed column indicates the number of failed claims within that batch. Click the number to open the claims within that batch only, or navigate to the Failed by Apex tab to access all failed claims.
- Click on the Claim Row to open the claim.
- Click the Delete button to delete the claim.
- Click the Stop Processing button to stop processing the claim.
- Click the Squares in the left hand column to select multiple claims, then use the buttons at the bottom to delete, stop processing or pend for attachment.
NOTE: You can also Search and Sort Failed Claims to make it easier to find the claim you're looking for.
Search and Sort Failed Claims
You can search by specific criteria without having to scroll through each failed claim listed.
Search Failed Claims
As you enter a patient name, batch name, payer name, or claim ID into the Search field, Apex will pull as-you-type results into the failed claims list.
Quickly search for claims of any status using the Claim Status drop-down list.
Select Date Range from the Drop-Down List
The default date range is one month. Click inside the Date Range field to select a date range of one month, three months, six months, or custom.
Set Custom Date Range
Enter Claims Start Date and Claims End Date to search for claims within a specific date range.
Show Entries Per Page
Apex will display up to 10 batches per page by default. Click inside the Show Entries field to show 25, 50 or 100 entries per page.
Navigate Between Pages
Apex will indicate how many failed claims are currently displayed and how many are left to view at the bottom of the list. Use the buttons at the bottom left to navigate to the First Page, Previous Page, Next Page, Last Page, or a specific page number.
Correct a Failed Claim
If a claim fails, you can make any necessary corrections from the Fails By Apex tab. Once all the required information is corrected and saved, the claim will be placed in a Ready status and be sent to the payer that night (or the following Monday if the claim was submitted over the weekend).
NOTE: Once a claim has been corrected and validated, it will display in a Blue Ready status on the All Claims tab.
NOTE: Common issues that cause claims to fail include:
- Missing patient or subscriber information.
- Procedure code is not valid.
- Diagnosis code requires further division.
- The provider on the claim is not recognized.
- The payer address or ID is not recognized.
- Click on the Claim Row to open the claim for editing.
- Review the Failed Validations box listing the reasons why the claim failed.
- Click inside each Yellow Box within the claim and enter the correct informaion.
NOTE: Each yellow box indicates the location of an error within the claim.
- Click the blue More link to expand areas on the claim that require corrections.
NOTE: If you can't find the information you need to correct, it's probably located under one of the More links within the claim. If you have clicked on every More link and are still unable to find the information you need to correct, please contact the Customer Care Specialist Team at 800-840-9152 or firstname.lastname@example.org.
- Click the Save Changes button at the top of the claim.
- The Claim Has Passed All Validations and is Ready for Processing message displays when all required corrections have been saved and the claim is ready to be sent out.