ClaimRev Support Documentation

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====== Claim Search ======

The **Claim Search** screen is your primary tool for finding, reviewing, and working claims in the ClaimRev Portal. Navigate here from the left menu: **Claims → Claim Search**.

{{:guides:img:claim-search-full.png?direct&800|Claim Search overview}}

The page is divided into three areas:
  * **Top Tabs** — switch between Claims, Reconciliation, and Provider views
  * **Main Area** — the claim results table with expandable detail rows
  * **Right Panel** — search filters and tools

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===== Search Filters (Right Panel) =====

{{:guides:img:claim-search-panel.png?direct&300|Search filters panel}}

The right-side panel contains all search criteria. Use any combination of filters to narrow your results:

  * **Payment Advice Status** — filter by ERA payment status
  * **Claim Type** — Professional, Institutional, or Dental
  * **Error Message** — search by error text
  * **Trace Number** — find a specific claim by its trace number
  * **Claim Ctrl Number** — search by claim control number
  * **Payer Ctrl Number** — search by payer-assigned control number
  * **Notes** — search within claim notes
  * **Group/Sort** — change how results are ordered (default: Received Date Ascending)

At the bottom of the panel you'll find:

  * **Queue Tools** — filters to help search claims based on queues
  * **Claim Admin** — tools to help admins manage claims (e.g., update status)
  * **Search** button — run the search
  * **Export CSV** button — download your search results as a CSV file

> **Tip:** Click the edge of the right panel to collapse or expand it, giving more room to the claims table.

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===== The Claims Table =====

{{:guides:img:claim-row-accepted.png?direct&800|Claim row showing an accepted claim}}

Each claim appears as a row with the following columns:

^ Column ^ What It Shows ^
| **Received Date** | Date and time the claim was received (e.g., 02/23/2026 9:02 AM) |
| **Status** | Four status icons in a grid — see [[#status_icons|Status Icons]] below |
| **Payer Info** | Payer name, payer number, control number, and claim type (Professional/Institutional/Dental) |
| **Provider Name** | Rendering provider name and NPI |
| **Patient Info** | Patient name (clickable), DOB, gender, and member number |
| **Claim Info** | Trace number, control number, billed amount, paid amount, and service date range |
| **Actions** | Action buttons — see [[#action_buttons|Action Buttons]] below |

**Row Colors:**
  * **Green background** — payer has accepted the claim
  * **Red/pink background** — claim was rejected (either during processing or by the payer)
  * **Yellow background** — claim is pending

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===== Status Icons =====

The Status column shows four icons arranged in a 2×2 grid. Each icon tells you where the claim stands in the processing pipeline:

^ Position ^ Label ^ What It Means ^
| Top-Left | **Received** | Claim processing status within ClaimRev |
| Top-Right | **File Status** | Whether the payer received and accepted the file |
| Bottom-Left | **Payer Acceptance** | Whether the payer accepted or rejected the claim itself |
| Bottom-Right | **ERA** | Whether payment information (835 ERA) has been matched |

==== Accepted Claim ====

{{:guides:img:claim-status-icons-accepted.png?direct|Status icons for an accepted claim}}

The claim has been successfully processed and accepted:
  * **Received** — green airplane, claim was sent to the payer
  * **File Status** — green airplane, payer accepted the file
  * **Payer Acceptance** — **green thumbs up**, payer accepted the claim
  * **ERA** — grey piggy bank, awaiting payment

==== Accepted and Paid (ERA Matched) ====

{{:guides:img:claim-status-icons-era.png?direct|Status icons for a paid claim with ERA matched}}

This is the complete happy path — the claim has been accepted **and** payment has been received:
  * **Received** — green airplane, claim was sent
  * **File Status** — green airplane, file accepted
  * **Payer Acceptance** — **green thumbs up**, claim accepted
  * **ERA** — **green piggy bank**, ERA has been received and matched

When the ERA is matched, the **Paid** amount in the Claim Info column will show the actual payment (e.g., $156.20 on a $200 billed claim). Click the **green piggy bank** icon to open the full ERA details and see the payment breakdown, adjustment codes, and any denials at the service line level.

==== Errored Claim (Not Sent) ====

{{:guides:img:claim-status-icons-errored.png?direct|Status icons for an errored claim}}

The claim has errors that prevented it from being sent to the payer:
  * **Received** — **red sick face**, claim was rejected during processing
  * **File Status** — grey pending, file was never sent
  * **Payer Acceptance** — grey pending, never reached the payer
  * **ERA** — grey piggy bank, no payment information

> **Important:** When you see a red sick face on the Received status, the claim has errors that must be fixed before it can be sent to the payer. Click the **Details** button and check the **Errors** tab to see what needs to be corrected.

==== Payer Rejected Claim ====

{{:guides:img:claim-status-icons-rejected.png?direct|Status icons for a payer-rejected claim}}

The claim was sent and the file was accepted, but the **payer rejected the claim itself**:
  * **Received** — green airplane, claim was sent successfully
  * **File Status** — green airplane, payer accepted the file
  * **Payer Acceptance** — **red sick face**, payer rejected the claim
  * **ERA** — grey piggy bank, no payment (claim was not processed)

Notice the pink/red row background — this immediately signals the claim needs attention. Unlike an errored claim that never left ClaimRev, a payer-rejected claim made it to the payer but was returned. You'll need to review the rejection reasons, correct the claim, and use **Replace/Void** to resubmit.

==== All Received Status Icons (Top-Left) ====

^ Icon ^ Color ^ Meaning ^
| Construction | — | Claim is being processed |
| Airplane (takeoff) | Green | Claim has been sent to the payer |
| Sick face | Red | Claim was rejected during processing |
| Stop | Red | Claim processing was stopped |
| Redo | Green | Claim has been reprocessed |

==== All File Status Icons (Top-Right) ====

^ Icon ^ Color ^ Meaning ^
| Airplane (landing) | Green | Payer accepted the file (999 acknowledgment received) |
| Sick face | Red | Payer rejected the file |
| Pending | Orange | Awaiting file acknowledgment |
| Hourglass | Orange | File acknowledgment in progress |

==== All Payer Acceptance Icons (Bottom-Left) ====

This is the most important status indicator — it tells you if the payer accepted your claim.

^ Icon ^ Color ^ Meaning ^
| **Thumbs Up** | **Green** | **Payer accepted the claim** |
| Sick face | Red | Payer rejected the claim — action needed |
| Pending | Orange | No acceptance status yet |
| Hourglass | Orange | Acceptance determination in progress |
| Clock | Light Blue | Pending at payer |
| Question mark | Grey | Unknown status |

> **Important:** The **green thumbs up** means the payer has acknowledged receipt of the claim and accepted it for processing. This does not necessarily mean the claim has been paid — check the ERA status for payment information.

==== All ERA Status Icons (Bottom-Right) ====

^ Icon ^ Color ^ Meaning ^
| Piggy bank | Green | ERA has been received and matched to this claim (clickable — opens ERA details) |
| Piggy bank | Red | ERA received but payment was denied |
| Piggy bank | Grey | No ERA matched yet |

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===== Action Buttons =====

Each claim row has action buttons on the right. The buttons shown depend on the claim's current status and your permissions.

==== Accepted Claim ====

{{:guides:img:claim-action-buttons.png?direct|Action buttons on an accepted claim}}

Shows the full set of actions including Replace/Void and the green checkmark (Mark As Worked).

==== Errored Claim ====

{{:guides:img:claim-action-buttons-errored.png?direct|Action buttons on an errored claim}}

Shows a **red exclamation mark** (Mark As Worked) indicating this claim needs attention. No Replace/Void option since it never reached the payer.

==== Payer Rejected Claim ====

{{:guides:img:claim-action-buttons-rejected.png?direct|Action buttons on a payer-rejected claim}}

Shows the **Replace/Void** button (circular arrows) — since the payer rejected this claim, you can correct it and resubmit a replacement, or void it entirely. Also shows the red exclamation (not yet worked).

==== All Action Buttons ====

^ Icon ^ Name ^ Description ^
| Info circle | **Details** | Expands the claim row to show detail tabs (Errors, Notes, Revisions, etc.) |
| Arrows | **Add to Compare** | Adds the claim to a comparison view for side-by-side review of multiple claims |
| Pencil | **Edit Claim** | Opens a menu with two options: **Editor 2.0 (New)** and **Classic Editor**. The editor varies by claim type (Professional, Institutional, or Dental). |
| Clock with actions | **Status Request** | Request a real-time status update from the payer. Only appears when the claim is eligible for a status check. |
| Upload file | **Upload Attachments** | Appears when the payer has requested additional documentation. Upload supporting files here. |
| Assignment alert | **Payer Requested Attachments** | Orange warning icon — indicates the payer is requesting additional information for this claim. |
| Replace arrows | **Replace/Void** | Available after a claim has been accepted or rejected by the payer. Use this to submit a corrected replacement claim or void the original. |
| Exclamation (red) / Checkmark (green) | **Mark As Worked / Not Worked** | Toggle to track your workflow. Red exclamation means "not worked yet." Green checkmark means "worked." Click to toggle. |
| X circle | **Mark Claim As Void** | Voids the claim, removing it from active processing. |

> **Tip:** Not all buttons appear on every claim. For example, **Replace/Void** only shows after payer acceptance or rejection, and **Upload Attachments** only shows when the payer has requested documents.

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===== Expanded Detail Tabs =====

Click the **Details** (info) button on any claim to expand it and reveal detail tabs:

{{:guides:img:claim-detail-tabs.png?direct&800|Detail tabs for an expanded claim}}

^ Tab ^ Description ^
| **Errors** | Shows processing errors and payer responses. Includes an **"Ask AI About Errors"** button that can help explain error codes. |
| **Notes** | View and add notes to the claim. Great for documenting follow-up actions. |
| **Revisions** | History of all changes made to the claim. |
| **Tags** | Labels assigned to the claim for categorization. |
| **Payer Acceptance** | Detailed payer acceptance/rejection information including reason codes. |
| **Payment Advices** | ERA payment details — amounts paid, adjustments, denial reasons. |
| **MIPS** | Quality reporting data (only visible if your account has MIPS enabled). |
| **Outbound Info** | Technical EDI transmission details (admin only). |
| **Utilities** | Administrative utility functions (admin only). |

==== Errors Tab: Accepted Claim ====

{{:guides:img:claim-errors-tab.png?direct&800|Errors tab showing accepted at payer status}}

When a claim is accepted, the Errors tab shows a confirmation message like "Acknowledgement/Receipt: The claim/encounter has been received" with an Error Type of **"Accepted At Payer"** and a Claim Status Code like **A1:20** (accepted for processing).

==== Errors Tab: Errored Claim ====

{{:guides:img:claim-errors-tab-errored.png?direct&800|Errors tab showing claim errors that need to be fixed}}

When a claim has processing errors, you'll see specific messages explaining what went wrong. In this example:
  * **"LOOP 2400 SEGMENT SV1 ... POINTING TO A DIAGNOSIS CODE >E66< THAT HAS EXPIRED"** — The diagnosis code E66 has expired and is no longer valid for the date of service.
  * **"LOOP 2300 SEGMENT HI INVALID DIAGNOSIS CODE E66"** — The diagnosis code is invalid and needs to be corrected.

**To fix:** Click the **Edit Claim** (pencil) button, correct the diagnosis code, and resubmit.

==== Errors Tab: Payer Rejected Claim ====

{{:guides:img:claim-errors-tab-rejected.png?direct&800|Errors tab showing payer rejection reasons}}

When a payer rejects a claim, you'll see detailed rejection reasons. In this example:
  * **Warnings** about subscriber segments being removed (N3, N4 segments — missing subscriber address fields)
  * **"Rejected At Payer"** with code **A3:21** — "The claim/encounter has been rejected and has not been entered into the adjudication system. Missing or invalid information."
  * **Additional Info:** "THE BILLING PROVIDER NPI (LOOP 2010AA, NM109) AND THE RENDERING PROVIDER NPI (LOOP 2310B, NM109) CANNOT BE THE SAME" — the billing and rendering provider NPIs must be different

**To fix:** Click **Edit Claim** to correct the issues (e.g., update the rendering provider NPI), then use the **Replace/Void** button to resubmit the corrected claim to the payer.

Each error row includes:

  * **Error Message** — the full text of the status or error
  * **Error Type** — category: "Warning" (informational), "Claim Error" (processing issue), or "Rejected At Payer" (payer rejection)
  * **EDI** — the specific EDI segment position where the issue was found
  * **Claim Status Code** — the industry-standard status code (e.g., A3:21)
  * **Actions** — gear icon for additional options

> **Tip:** Click **"Ask AI About Errors"** in the top-right corner to get an AI-powered explanation of the error codes and suggestions for how to fix them. This is especially helpful for complex EDI errors and payer-specific rejection reasons.

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===== Top Tabs =====

^ Tab ^ Description ^
| **Claims** | The default view — shows individual claim rows with all details described above |
| **Reconciliation** | Summary view of payment reconciliation data for your search results |
| **Provider** | Groups claims by rendering provider for a provider-level summary |

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===== Tips for Working Claims =====

  * Click a **patient name** (shown as a link) to go to **Sharp Revenue** where you can run an eligibility check for that patient
  * Use the **checkbox** on the left of each claim to select multiple claims for bulk actions
  * If **Paid** shows "$" with no amount, the ERA has not been received yet
  * Use **Export CSV** to pull claim data into a spreadsheet for further analysis
  * The **Group/Sort** control lets you change ordering — useful when working through a large set of claims
  * When fixing rejected claims, always use **Replace/Void** rather than submitting a brand new claim — this links the replacement to the original for proper tracking

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//See also: [[guides:uploading-claim-files|How to Upload Claim Files]]//

//Need help? Contact ClaimRev support.//