Claims

A claim is what NeatPractice sends to a payer: the ready charges of one patient grouped the way payers expect them. Open Claims in the Billing panel of the main menu to see them.

Create claims#

In Charge review, select ready charges and choose Create Claims. NeatPractice checks the charges once more, skips any that are held, not yet released or billed to the patient (self-pay), and groups the rest:

• one claim per patient, payer, billing location, rendering provider and date of service;
• a different authorization, referring provider or place of service starts another claim;
• a payer whose billing rules combine dates of service gets one claim across dates;
• a claim holds at most the payer's line limit (50 electronic or 6 on paper by default) and twelve diagnoses, and the rest goes on further claims.

Each claim gets a claim number, which is also the patient control number the payer sees. The charges become Billed and cannot be billed again. If another biller creates claims for the same charges at the same moment, only one claim is built and the other biller is told the charges changed; reload to see the claim that was built.

Review a claim#

Click a claim to open it. The Claim tab shows the patient, payer, providers, dates and diagnoses. While the claim is a Draft you can fill in:

• Box 19 additional information
• Message on the claim, printed on paper claims
• Internal notes, never sent
• Delay reason code, for a claim sent past the payer's timely filing limit

Scrub Claim, Submit, Print Claim and Preview CMS-1500 work on the saved claim. If you changed these fields without saving, NeatPractice asks you to save or discard the changes first. Saving sends a scrubbed claim back to Draft, so scrub it again before you print it. Your unsaved text stays in place when the claim refreshes in the background; if someone else saved a field you are editing, a notice says so and Use Saved Version takes theirs.

The Lines tab lists the charges on the claim. On a draft, Remove from Claim takes a line off; its charge goes back to Ready and the claim renumbers its lines. The Clearinghouse tab lists the claim's rejections, each with its code, full explanation and a hint on how to fix it, and the payer's full status check answers, and the Claim tab shows the clearinghouse's id for the claim, the payer's claim number and when it was submitted. The History tab shows every status change, including the ones the clearinghouse and payer caused.

Claim form map#

The Form Map tab lists every value the claim prints and sends: the CMS-1500 box, the electronic claim's loop and segment, and the value itself. Hover a value to see where it lands and which record it came from, such as the location's billing provider, the provider's enrollment number or the patient's coverage. Turn on Show empty to see the fields the claim leaves blank. To change a value, change its source in setup or in the chart; claim boxes are never typed over by hand (see Payers).

Proof of timely filing#

When a payer denies a claim for timely filing, open the claim and choose Proof of Timely Filing in the more actions menu. NeatPractice builds a PDF with a cover letter to the payer and the claim's submission record: each time it was sent, the clearinghouse's acceptance, the payer's acknowledgment and any mailing date, with their control numbers. Claims it replaces are included, so the record goes back to the first filing. Review and sign the letter before you send it with your appeal. The option shows once a claim has been sent or mailed.

Before a claim leaves the clinic#

Before a claim can leave the clinic, Scrub Claim checks it; the Scrubber tab shows what to fix (see Claim scrubber). A scrubbed claim can be printed for mailing (see Paper claims and claim forms).

To cancel a draft, choose Void Claim in the more actions menu at the bottom of the claim, check the claim number, patient, payer and lines it names, and give a reason. Its charges go back to Ready. A claim is never deleted.

Attach supporting documents#

Some payers want records with a claim, such as the plan of care or therapy notes. On a draft claim, open the Attachments tab and choose Attach Document. Pick a document from the patient's chart (the newest files show first; type part of the file name or description to search the whole chart), what kind of document it is, and how it reaches the payer (By fax, By mail, or Available on request at the clinic). The electronic claim tells the payer the document is coming, with a control number such as C100001A1; write that number on the cover sheet you send with it. Upload new documents from the chart's Documents page first. Attachments can change only while the claim is a draft. On any claim, View or Download in an attachment's menu opens the chart document without leaving the claim.

Summary before you submit#

Select claims in the list and choose Summary (Excel) or Summary (PDF) to check them before they go out. The file has three tables:

• By patient: claims, units, hours, billed and expected payment for each patient.
• By credential: the same totals for each delivering provider's credential (such as CCC-SLP or BCBA), so you can see the expected payment for each kind of provider.
• Claims: each claim with its patient, payer, dates of service, status and totals.

The expected payment is the allowed amount from the payer's fee schedule, or the billed amount on a line without one. Nothing about the claims changes. The summary is recorded in the access log.

Submit claims#

Electronic claims go to the payer through the clinic's clearinghouse.

1. Select claims in the list and choose Submit, or open a draft and choose Submit in its header.
2. NeatPractice scrubs each claim first and saves what it found on the claim's Scrubber tab. A claim with a problem to fix is skipped and the message says why. A problem that can be overridden is overridden when you have the override permission and give a reason; otherwise the claim is skipped until someone does.
3. The claims become Queued and, within seconds, Sent once the clearinghouse takes them, or Clearinghouse rejected with the errors it returned.

A claim that is already queued or sent cannot be submitted again; correct it with a new claim instead. Paper claims and voided claims are skipped. If the clearinghouse cannot be reached for a while, the claim goes back to Scrubbed and nothing was sent, so you can submit it again.

Every submission, and every print for mailing, becomes a numbered batch in Claim batches with its billed, allowed and paid totals. To follow up on claims a payer has not paid, use Claim aging.

After a claim is sent, the payer's acknowledgment moves it to Accepted, Pending or Payer rejected automatically. Rejected claims are worked in Rejections.

Each claim the clearinghouse accepts counts toward your plan's monthly electronic claims allowance; its remittance and acknowledgments come with it, and status checks are free. If your plan stops at the allowance and it is used up, Submit says so and no claim in the batch is sent. See plan usage and packs.

Check a claim's status#

On a sent, accepted, pending or payer-rejected claim, choose Check Status to ask the payer where it stands. The answer is saved on the Clearinghouse tab and moves the claim when the payer says it was accepted, pended or rejected. A claim the payer has finished processing stays as it is until its remittance arrives.

NeatPractice also asks automatically: every night it checks electronic claims that have had no answer for the number of days set in Clearinghouse settings. To run that check now, choose Check Unanswered Claims in the header menu of the claims list.

Bill the next payer#

When a patient has a second (or third) coverage on the dates of service, the next payer is billed once the first one has processed the claim. Payments posted from a remittance do this on their own. For a paper explanation of benefits, open the claim and choose Bill Next Payer. The dialog names the payer the next claim goes to; when no other coverage takes claims on those dates, it says so, links to the patient's coverage and makes no claim. Then enter:

• Processed on and Paid on the claim, from the explanation of benefits.
• Any adjustments to the claim as a whole, each with its group (for example CO for contractual or PR for patient responsibility), reason code and amount. An adjustment amount can be negative, for example when the payer reverses part of an earlier adjustment; paid amounts are zero or more.
• For each line, what was paid (enter 0 when nothing was; blank is not zero) and its adjustments.

Choose Bill Next Payer. NeatPractice creates a draft claim for the next coverage with the same services, carrying what the first payer paid and adjusted (box 29 on paper). Review and submit it like any other claim. If the first payer forwarded the claim to the next payer itself, turn on The payer forwarded the claim to the next payer and no new claim is made. To find these drafts, filter the claims list by Payer order.

Statuses#

A claim that has left the clinic is never edited. Corrections are made with a replacement or void claim.

Outcome of an adjudicated claim#

Once a payment is posted for a claim, an Adjudicated or Closed claim also shows what the payer did with it, in the claims list, the patient's billing tab and the claim itself:

The outcome counts every payment posted for the claim that has not been reversed. A later payment or a reversal updates it, and a claim whose payments were all reversed shows no outcome.

Correct a claim the payer has#

Once a claim is with the payer (sent, accepted, pending, adjudicated, printed or closed), open it and choose:

• Replace Claim creates a replacement claim (frequency 7). Lines a visit addendum changed are rebuilt from the corrected visit; the other lines are carried over. What was already paid, written off or transferred on a rebuilt line moves to its new charge, so a payer reversal of the first payment later finds it there.
• Void with Payer creates a void claim (frequency 8) carrying every line. Leave Rebuild the charges for rebilling on to get fresh charges in charge review once the payer takes the void, for example to bill the right payer.

Both need a reason and the payer's claim number for the original claim, which goes in box 22. NeatPractice fills it in when the payer's number is on file. The correction starts as a draft, opens in place of the original with a Corrects link back to it, and goes out like any other claim. It takes effect once the payer accepts it, or once a paper claim is printed: a void then marks the original Voided, and a replacement voids the charges it left out. The claim shows its corrections, and a correction links back to the claim it corrects.

A rejected claim was never adjudicated: fix it and send it again instead of correcting it. When a visit changes after billing, the claim waits in Claim corrections.

Find claims#

The list shows the last 90 days, newest first. Search above the table by claim number, the payer's or clearinghouse's claim number, member ID, patient name or chart number, or a date of service such as 10/05/2026. Pick other dates, click Filter to narrow by status, payer, provider, Payer order or Status age (how long a claim has sat in its status), and turn on Hide submitted to see only claims still in the clinic. Pick patients in the patient panel to see only their claims, or providers on its Providers tab to see the claims they rendered. Click a column header to sort by it, for example by Total to work the largest claims first. Hover the line count to see the claim's lines. Search text is never put in the page address.

File by is the last day the payer accepts the claim, counted from the first date of service by the payer's filing limit (its corrected-claim limit for a replacement or void). A claim still in the clinic shows how many days are left once 30 or fewer remain, or how late it is.

The visit screen shows the claim number each visit is on, linked to the claim.