Check the Payor’s Status on a Claim

Has your claim been received by the payor? Have they adjudicated it yet? What’s the status? You can click a button and instantly receive a claim status report from the payor. Instead of opening the payor’s website or calling them, you can read the payor’s latest claim status right in PCC EHR.

PCC EHR Only, Participating Payors Only: Real-time claim status is available from participating payors for claims submitted through the PCC EHR Claims tool. If you use PCC’s legacy Practice Management suite, Partner, check out Submit Claims and get in touch if you’d like help making the transition or have questions about a specific payor.

Video: To see a claim status request in action, in the context of the Unpaid Encounters worklist, watch Follow Up on Unpaid Encounters with Insurance Balances.

Use the Unpaid Encounters worklist to check the status of any unpaid claim.

Open the Unpaid Encounters Worklist

Open the Insurance Balances tool and select the Unpaid Encounters worklist.

Select a Payor or “Work With All”

If you are working down claims for a specific payor, double-click on that payor to see all of their claims.

Otherwise, you can click “Work With All” to see all outstanding claims for your practice.

Select the Encounter

Use the search field, sort by a column, and select criteria options to quickly find the encounter in question.

Double-click on the encounter to see more details.

Request Claim Status from the Payor

Then click “Request Claim Status” to query the payor.

If the payor is in compliance with claim status standards, they will return a result for that encounter, and PCC will format and display the result.

Payor Usage Limits: Most payors do not provide claim status information until seven days after a claim has been submitted. Some payors will not respond to a second query within twenty-four hours. PCC can’t control whether a payor will respond, but you can follow these guidelines to improve the likelihood of receiving information on an unpaid claim.

Here are some related articles in Billing and Practice Management > Bill Insurance:

Follow Up on Unpaid Encounters with Insurance Balances
Use the Unpaid Encounters worklist to track your practice’s insurance A/R and keep tabs on unpaid claims.
Follow Up on Unpaid Encounters with Insurance Balances
After submitting claims and dealing with rejections, use the Unpaid Encounters worklist to followup on unpaid claims with insurance balances.
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Your practices receives many different electronic responses to claim submissions and billing. Read this article to learn the different EDI responses, which responses require attention, and how to use PCC's tools to review and respond.
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PCC's insurance billing tools help you process and prepare claims, send them electronically or print them, review rejections and denials, fix problems and resubmit, and work down your insurance accounts receivable. You can maximize the use of your time as you pursue proper insurance reimbursement.
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After you submit claims, your practice will receive clearinghouse and payor acknowledgements as well as ERAs and other electronic notifications from PCC, claim clearinghouses, and payors. You can use tools in PCC EHR to review these responses. When you need to do deeper research, you can use the EDI Reports (ecsreports) program.
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Configure Capitation and Capitated Plans
Capitation payments are not like other income. How should you configure PCC EHR in order to track payments you receive as part of your participation with a capitation insurance plan? PCC Support will complete the steps in this article for you, but you may find the instructions helpful if you are a system administrator or practice manager and make updates to your PCC tables.
Edit the Insurance Plans on Your PCC System
Use the Tables tool in PCC EHR to add a new insurance plan and configure the payors you send claims to.
Submit Claims
Prepare and submit claims. Then work on any claims that were stuck and couldn't be submitted.
Configure Claim Holds and Claim Delay
Watch this video to learn how to hold claims for specific providers, locations, or plans and how to configure your practice's claim delay.
Configure Claim Holds and Claim Delay
When your practice needs to prevent certain claims from being submitted, you can create a claim hold. A claim hold prevents claims from going out for specific dates of service, billing providers, places of service, and insurance plans. You can also configure your practice’s claim delay, which prevents any claim from going out until a certain number of days after the date of service.
Work on Claim Errors, Rejections, and All Unpaid Claims
After you prepare and submit claims, you must deal with claims that could not be submitted or were rejected.
Claim Processing and Needs Correction Error Reference
What kinds of pre-submission processing does your PCC system do on claims? What errors can it find, and how do you fix them?
Track Newborn Charges and Delay Billing the Family
If you bill for newborn encounters before the family has updated their insurance, will your PCC system send them a large bill? Your practice can add a newborn patient to your PCC system, track newborn hospital and office encounters, and delay billing until the family has updated their insurance information. Read below to learn more.
Respond to Claim Rejections
If unaddressed, rejected claims result in lost revenue. Use the Rejected Claims worklist to review and respond to every claim rejection sent to your practice.
Respond to Claim Rejections
If unaddressed, rejected claims result in lost revenue. Use the Rejected Claims worklist in the Insurance Balances tool to review and respond to every claim rejection sent to your practice.
Print Paper HCFA Claim Forms
Sometimes, you still need a HCFA! In those rare cases when you need paper claims, you can print a batch in the Claims tool or print a single claim from Edit Charges.

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