Working Claim Rejections (Change Healthcare Portal)

Let’s review how to work your claim rejections in the Change Healthcare portal.  

Locating Rejections 

To access this report: 

1. Navigate and log in to https://portal.capario.net. 
2. Open the Rejections and Denials menu.
3. Select Find All Rejected Claims.
4. Enter your Billing Provider Tax ID.
   1. You can narrow your rejection list by entering in the CH Processing Date Range. Tip: We recommend looking at a three-month date range, to ensure you’re capturing payers who are delayed in processing claims.
5. You will only work claims with the Status of In Process. Open the Claim Workflow Status drop-down from the Workflow Identification section.
6. Select In Process.
7. We recommend sorting your results by Patient Account #. Click SEARCH to view rejections for the date range entered. 
8. The results display below the parameters, with the rejection message appearing in red font. 
9. To work a rejection, click on the Trace ID. This is a unique identifier for the claim.
10. Within the Claim Details page, you can view pertinent information such as type (primary, secondary, etc.), rendering provider, billing provider, and charge details.
11. At the top of the Claim Details screen, you have a menu that allows you to view additional details such as the Claim Data.
12. You’ll need to manually close the rejection once you’ve worked it.

When should I correct a rejection in Change Healthcare versus in the WebPT System? 

We recommend only making corrections in Change Healthcare for things that do not change the claims itself. This includes primarily small formatting issues, like an extra semi-colon in the modifier’s field which is impacting the modifier positioning, or an extra space in a claim field.

Everything else should be fixed in the WebPT systems, like patient account numbers or adding modifiers to the claim. This ensures that the claims do not continue to reject for the same reason (i.e. invalid subscriber ID) each time a claim is submitted for that patient.

Let’s walk through an example: 

1. The claim was rejected for incorrect subscriber ID. 
2. Update the subscriber ID in the WebPT EMR. 
3. Rebill the claim from WebPT Billing and make an Account Note on the patient’s chart. The claim will rebill that evening with the updated subscriber ID. 
4. Close the rejection in Change Healthcare.

EDI Tab 

1. You’ll leverage the EDI tab to research claim rejections.
2. When you open the EDI tab of the Claim, you can view the following information:
   1. Phoenix Inbound: This is the information that was sent out of WebPT Billing.
   2. Common: This is where Change Healthcare has added information to the claim prior to sending such as submitter ID.
   3. Outbound: This is what was actually sent out of Change Healthcare to the payer.

Bulk Close Rejections 

For situations where you had many claims rejected for the same reason, and you’ve made the necessary updates to those claims and rebilled from WebPT Billing, you can use the bulk updates functionality to close these items. 

1. From the Find All Rejected Claims page, click on the Show Bulk Update Options link.
2. Use the checkboxes to select the rejection messages you want to close.
3. From the Select Status drop-down, choose Close.
4. Add your user name and the reason you’re closing these items into the -- Enter Notes Here -- field.
5. Click Submit for these items will be removed from the list.