Create, validate, and submit the claim

Create and validate the claim

1. Open the completed appointment in the Calendar and go to the Billing tab.
2. Check the services, diagnosis, place of service, and insurance details already filled in.
3. Click Create claim. If it isn't the main button, you'll find it in the ⋮ menu beside it, or on the payer's card in the Insurance section.
4. On the claim, complete any missing details. If the payer needs prior authorisation, enter the number in Prior authorization number (box 23) under Miscellaneous information.
5. Click Validate.

Validation checks for errors that could cause a payer to reject the claim before you send it. If the client owes a co-pay, select Create invoice from the same tab.

Submit the claim and follow its status

Click Submit electronically. The status changes to Submitted. You can follow the claim in Billing → Claims. You'll see the status in the claim header, payer messages under the History icon, and changes through in-app notifications. Use the Comments tab in History to note calls and updates for your team, and Add follow-up to set a date to chase it.

During the free trial, Submit electronically shows an upgrade prompt instead, because electronic claims need a paid plan. You can still export or print the CMS-1500 and send it yourself.

You only need to act when a claim is Rejected or Denied. The other statuses, Draft, Validated, Submitted, Accepted, Paid, Processed, and Closed, show where the claim is up to.

Fix common claim problems

Most problems come from an earlier step. Once you know what happened, you can usually find the right place to correct it.

• The eligibility check failed. A detail may be missing from the client's or policyholder's profile, or your payer enrolment may still be processing. Add the names and dates of birth to both profiles, then try again with one benefit code.
• Coverage shows inactive. The policy may have lapsed, or a detail may be incorrect. Compare it with the card and confirm the coverage with the client before the session.
• A session didn't become a claim. The appointment may be missing a service or diagnosis. Check both codes on the appointment's Billing tab, then create the claim.
• The claim was sent with the wrong code. The CPT code wasn't confirmed before you created the claim. Correct the claim and submit it again.
• The claim was denied for place of service. The Location didn't match where the session took place. Correct the appointment, then fix the claim and submit it again.
• The claim was denied for prior authorisation. The Prior authorization number was missing or wrong. For the next session, get the number from the payer beforehand and enter it on the claim.
• A no-show fee wasn't charged. The appointment wasn't marked Did not attend. Update the status, then invoice the fee if your policy allows it.

Submit secondary claims or use the RCM service

If the client has secondary coverage, open the primary claim → Create secondary claim → choose the secondary policy, then submit it in the same way.

If your practice uses Carepatron's RCM service, the billing team completes this final step for you. They create, check, and submit claims, then handle rejections and denials. You'll still complete the earlier lessons because the billing team uses that information to prepare each claim.