A rejected claim is not a lost claim. It was sent back before the payer processed it, and it can be corrected and sent again. The Rejections tab shows every one of them, grouped by reason, and tells you whose step each group is.
This article is for practices whose RTM claims SaRA files. If your own team bills from your EMR, see The Billing page: your complete worklist.
Where to look
Open Billing and choose the Rejections tab. At the top are four cards:
Claims sent back: the total, and how many groups they fall into.
SaRA's step: we are correcting something or waiting on an approval we asked for. Nothing is needed from your office.
Payer's step: the payer owes an answer. Nothing is needed from your office.
Your clinic's step: something on the patient's chart needs a check. Click this card to jump to the first group that needs you.
Below the cards, each group shows the reason in plain words, the payer, how many claims are in it, and what happens next. When a group is sent again, its rows move to the Submitted tab and the group leaves the list.
When it is your clinic's step
These are the only groups your office acts on. In each case you check one thing on the patient's chart against the insurance card or the referral, correct it if it is different, and SaRA sends the claim again the next business day.
What the group says | What to do |
The payer could not match the patient's member ID | Check the member ID on the chart against the insurance card, front and back. If it changed, update it. |
The payer could not match the patient's name to the policy | Check the name on the chart against the card, including the policy holder if the plan is under someone else. |
The payer needs a date of injury on the claim | Add the date of injury on the patient's chart. Workers' compensation payers require it. |
The payer did not find coverage for the patient on the date of service | Check the patient's insurance on the chart. If it changed, update it and SaRA sends the claim to the right payer. |
If a claim comes back because a diagnosis code is no longer accepted, we will tell you which claim and which codes can replace it. The treating therapist chooses the code that fits, and we send the claim again.
When it is SaRA's step or the payer's step
You do not need to do anything for these. The group tells you what we are doing.
Waiting on payer enrollment. Before a payer accepts claims we send for you, it has to approve SaRA as the sender for your practice. Until it does, claims for that payer are returned and wait in this group. They are queued, not lost, and we send them again the day the approval lands. The approval date belongs to the payer, so this group shows no date. More on how enrollment works: Payer enrollment: the journey from form to first payment.
Waiting on a SaRA fix. We sent something in a format the payer or clearinghouse would not take. We correct it and send the whole group again together.
Under review by SaRA. The payer or clearinghouse gave a reason we have not seen before. We read each of these by hand and then name the reason and the next step on the tab.
Payer asked for more detail. The payer returned the claim without saying which field it wants. We pull the payer's full response to find out. If it turns out to be something on the chart, the group moves to Your clinic's step.
How long until the money arrives
The clock starts when a payer accepts a claim, not when it was first sent. From acceptance, payment has typically reached the practice in two to six weeks. Medicare does not pay before the 14th day by its own rules.
A claim in a rejection group has not started that clock yet. That is why an enrollment that is still pending matters more than anything else on the tab: every claim behind it starts its two to six weeks on the day the payer approves.
When a call helps, and when it does not
A call cannot make a payer approve an enrollment sooner, and it does not change the order claims are sent again. For those groups the tab is the fastest way to see where things stand, because it updates the day anything moves.
Writing to us does help when a group is your clinic's step and the fix is not clear, or when the same claim comes back after you corrected the chart. Message us through the chat in SaRA with the group name and we will answer there. If writing does not settle it, we will set up a call.