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How to Correct Returned Claims in Workflow Services

Updated

 

🔁 What Are Returned Claims?

Returned claims are insurance claims that have either:

  • Failed (due to missing/invalid information), or
  • Been denied by the payer.

These claims have been reviewed by our billing team and require additional corrections—most commonly insurance information updates—before they can be resubmitted for reimbursement. 

Payers may have "timely filing" limits which would prevent reimbursement after a defined period of time. It's important to be aware of each payer's requirements and resubmit corrected claims as soon as possible after the original submission. 

 

🔍 How to Find Returned Claims

  1. Log in to the Workflow Services Web Portal.
  2. Click on the Claims tab.
  3. In the filter bar at the top, locate the Status dropdown.
  4. Check the box for Returned. (Non-admin users will have fewer choices than shown below.)
  5. Click the Search button on the far right.

✅ This displays a list of all claims that have been marked as "Returned" and need review.

 

📝 How to Review Returned Claims

  1. Hover over any row in the Returned claims list.
  2. Click the Edit icon (a bent arrow) that appears on the far right of the row.
  3. A pop-up window will open with the claim details.
  4. Scroll down to view:
    • Reason for Status
    • Notes for the Provider - notes from the billing team explaining why the claim was returned


Common Return Reason:

  • Incorrect or missing insurance ID
  • Invalid payer name
  • Expired or mismatched insurance coverage
     

📸 How to Correct Insurance Information

Option 1: Update insurance information manually

If you have access to the insurance information you can enter new insurance information manually in the Patient Profile following these instructions.

Once the insurance information has been added to the patient's profile complete the editing process by:

  1. Return to the Returned Claim Editor.
  2. Select the new payer in the Insurance Cards field from the drop down menu.

Returned Insurance.png
 3. Save as Ready.

4. Return to the Claims page and hover over the line with the claim you are working on.

5. Click Submit to submit the claim.

Submit.png


Option 2: Use the Built-In Request Feature

You can request insurance info directly from within the claim:

  1. Scroll to the bottom of the claim screen.
  2. Click Request Insurance Coverage.
    Insure.png

📱 This sends a text message to the patient asking them to upload a photo of the front and back of their insurance card.

  • Once submitted, the image will automatically appear in the patient’s profile and on the related claim.
     

✅ Automatic Status Update and Resubmission

If you use Option 2, once you update the insurance information using the uploaded card:

  • The claim status will automatically change from Returned to Ready.
  • In Ready status, the claim will be automatically resubmitted to the payer.

⏱️ No need to manually resubmit! Just confirm the updated info is correct.

 

💡 Tips for Success

  • Check for typos or incorrect entry when adding insurance details.
  • Ensure the payer name and ID number exactly match the patient’s insurance card.
  • Follow up with patients if the card image isn’t received within 24–48 hours.
  • Review Returned claims regularly to avoid processing delays.
     

📬 Still Need Help?

If you encounter any issues updating a claim, reach out to the Workflow Services Support Team:
📧 support@imagemover.com 

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