How to Rebill or Resubmit Claims

In this help guide, we will show you how you can resubmit a claim both through the ERA as well as manually through Patient Billing. Once your claim has been submitted to the insurance, the claim comes back as an ERA or through email as an EOB. Once it comes back as an ERA, you must post it and change the Action. Let's check out how to rebill a claim.

A. Rebill a Claim through ERA

1. Click on the green colored circle at the top navigation bar as shown here. You will see a list of the ERAs here. Next, find the ERA that you want to rebill. Click on "Post ERA Payments".

2. On the ERA, you will be able to see the insurance paid amounts, adjusted amounts, reasons, and patient responsibility (if any).  a. Now, change the "Action" to "Rebill" b. Click "Apply Payments"

3. Once you apply those payments to the ERA, you can see the claim status has changed to RE (code for rebill). To check this, either you can: a. Navigate to the Patient Chart. Click "Patient Billing". You will see the Active Claim Status for the claim as "RE". b. Click the "red colord circle" at the top navigation bar. Find the ERA you just posted. You will see the Active Claim Status for the claim as "RE".

4. Based on what changes the insurance asked you to make to the claim, such as Patient Contact Details, Provider Billing Details, or missing modifiers, go ahead and do the changes. For instance, a. If you need to make changes to the Patient's contact or insurance details, navigate to the Patient Chart. Add the necessary details and save the details. b. If there are changes that you need to make to the Invoice, click the Invoice as shown here. If you need to add a modifier to a CPT code, add the modifier and click the "Save" icon as shown in the second screenshot. If you need to change ICD-10 code, add the new codes, check the pointers and then click "Save and Recalculate" on the bottom left side.

5. Once you made the necessary changes, click the red colored circle at the top navigation bar. Find the ERA. Click "Edit Primary Claim" as shown here. The HCFA form will open. Scroll down to the bottom then HCFA form, and click "Submit Claim".

B. Rebill a Claim Manually 

Note: Only rebill a claim manually when you didn't receive an ERA or EOB, such as when you receive a call from the insurance company about errors in a claim.

1. In order to manually rebill a claim, navigate to the patient chart. Go to the Patient Billing tab. Find the claim. Next, click "Edit Claim Status" a. On the pop-up window, select "2E/RE Received Error Acknowledgment from Clearinghouse" from the drop-down. b. Click "Confirm & Update". On the pop-window, click "Confirm" again.

2. Once you change the status, the HCFA form opens up automatically. Review the HCFA form, make changes if necessary, and click "Submit Claim". Navigate to the Patient Chart > Patient Billing tab. Find the claim. You will see the Active Claim Status as "2E", signifying that there isn't any error on this and you can resubmit the claim.

C. Watch the video - How to Rebill or Resubmit a Claim

D. How to Rebill or Resubmit a Claim to the Correct Insurance Company - From the ERA Screen

Here is the process for resubmitting a claim (same claim, just different insurance company) to the correct insurance company.

1. Click on the green colored circle at the top navigation bar as shown here. You will see a list of the ERAs here. Next, find the ERA (with the incorrect insurance name) that you want to rebill. Click on "Post ERA Payments".

2. On the ERA, you will be able to see the insurance paid amounts, adjusted amounts, reasons, and patient responsibility (if any). a. Now, change the "Action" to "Rebill" b. Click "Apply Payments".

3. Once, you have changed the ERA Action to Rebill, now change the Insurance name in the Patient Chart. Go to the Patient Chart. Click Contact Details > Click Primary Insurance. Add insurance name, plan name, member ID, copay, effective dat (if available), and other necessary insurance details. Click "Save"

4. Once you added the correct insurance company name and ID to the Patient Chart, click the red colored circle at the top navigation bar. Find the ERA. Click "Edit Primary Claim" as shown here. The HCFA form will open. Review the HCFA to see if the correct insurance name now reflects on the form. Then, scroll down to the bottom then HCFA form, and click "Submit Claim".

E. How to Rebill or Resubmit a Claim to the Correct Insurance Company - Manually From the ERA Screen

If you didn't get an ERA back, you can manually change claim status to 2E (signifying an error). Usually, you wouldn't want to change anything until you heard from the insurance, but this was the incorrect insurance anyway so it isn't going back to you. To change the Claim Status, go to Patient Chart > Patient Billing. Find the Claim > Click Edit Claim Status > Change Status to 2E. Click "Confirm & Update". Finally, click "Confirm" to proceed.

2. When you change the status to 2E, the HCFA form opens up automatically. uUse the drop down for the Box 11c to choose the correct insurance. Click "Submit Claim".

F. How to Rebill a Claim from the EOB Screen

If you get an EOB back in the mail and you want to rebill the claim because of the incorrect insurance or missing patient information, or other details, you can do it directly from the EOB screen in your zHealth account.

1. At the top right corner of the zHealth Dashboard, you will see Your Name (Provider Name). Hover the cursor over your name and a drop-down menu will open. Click on - Billing Center. The Billing window will open. At the Billing Center page, there is an option - EOB. Click on the EOB button.

2. You can search EOBs based on Date Range, Insurance Name or Patient Name. Click Search after selecting your criteria. A list of EOBs will come up based on the insurance company you selected. When you have a list of EOBs populated on the screen based on the Insurance Company or Patient Name you searched for, you need to click the checkbox under the 'Select' column to select the EOB you want to rebill.

3. On the EOB screen, you will be able to see the insurance paid amounts, adjusted amounts, reasons, and patient responsibility (if any).  a. Now, change the "Action" to "Rebill" b. Click "Apply Payments".

4. Once, you have changed the EOB Action to Rebill, now you need to make the changes as requested by the insurance company. If you billed the wrong insurance, you need to change the Insurance name in the Patient Chart. Go to the Patient Chart. Click Contact Details > Click Primary Insurance. Add insurance name, plan name, member ID, copay, effective dat (if available), and other necessary insurance details. Click "Save" [First screenshot] If you have not added modifiers to the CPT codes in the invoice, go ahead and open the Patient Chart > Patient Billing Tab. Search for the invoice, open it, and add the correct modifiers to the CPT codes. Click "Recalculate and Save".

5. Once you made the necessary changes, click the red colored circle at the top navigation bar. Find the claim you want to resubmit. Click "Edit Primary Claim" as shown here. The HCFA form will open. Scroll down to the bottom then HCFA form, and click "Submit Claim".

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