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Managing Medical Claims

This guide explains how to manage claims within the MedFlow IO portal. It covers how to access claims, review claim request details, check payer responses, and resubmit claims when necessary.

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Written by Regina Arbolante
Updated over 3 months ago

Objective

To help practice staff and billing teams efficiently handle claims, reduce denials, and ensure accurate reimbursement through proper use of the Request, Response, and Resubmission tabs.

Key Steps

Step 1: Accessing the Claims Page

  1. Log in to the MedFlow IO portal.

  2. From the left navigation menu, go to the Medical section.

  3. Select Claims.

  4. The Claims List will display, showing all available claims.

Step 2: Selecting a Claim to Manage

  1. Review the claims list and locate the claim you need to manage.

    • Common columns displayed include:

      • Claim Status

      • Date Submitted

      • Patient Name

      • Total Charges

      • Provider Name

      • Control Number

  2. Apply filters (by patient name, date of service, claim number, or status) to quickly find the right claim.

  3. Click on the claim row to open its details.
    ​

  4. The claim detail view will display three tabs:

    • Request

    • Response

    • Resubmission

Request

The Request tab displays the original claim submission.

Steps

  1. Review Claim Preview to verify submitted details.

  2. Check the Claim Status field to confirm whether the claim is Draft, Submitted, or Pending.

    • If needed, use Change Claim Status and click Update Status.

    • Use Check Claim Status to refresh real-time updates from the payer.

  3. Confirm Submitter Information (organization, contact details, submission date).

  4. Verify Receiver Information (payer, payer code, jurisdiction).

  5. Review Billing Provider Information:

    • NPI

    • Organization Name

    • Tax ID

    • Address

    • Phone (if available)

  6. Check Rendering Provider Information and Referring Provider Information to ensure they match the demo file.

  7. Confirm Patient (Subscriber) Information:

    • Member ID

    • Name, Date of Birth, Gender

    • Address and Phone (if provided)

  8. Review Claim Information:

    • Patient Control Number

    • Total Charge Amount

    • Place of Service Code

    • Diagnosis Codes

  9. Review Service Lines to ensure procedures, modifiers, units, and charges are accurate.

  10. If corrections are needed, click Edit and Resubmit Claim.

Response

The Response tab shows the payer’s acknowledgment of the claim.

Steps

  1. Review the Status field to confirm whether the claim was accepted (SUCCESS) or rejected.

  2. Note the Control Number and Correlation ID for tracking.

  3. Confirm the Payer field — if marked Unknown, verify the payer details in the original claim submission.

  4. Check Edit Status to see if the claim passed format validation.

  5. Review claim reference details:

    • Claim Type (e.g., PRO for Professional)

    • Submitter ID

    • Format Version (e.g., 5010)

    • Rhclaim Number

    • Time of Response

    • Customer Claim Number

    • Patient Control Number

  6. Use this information to reconcile payer acknowledgments with your billing records.

Resubmission

The Resubmission tab allows you to fix errors or resubmit claims.

Steps

  1. Select the Payer from the dropdown search.

  2. Confirm Subscriber, Billing Provider, Rendering Provider, and Referring Provider fields.

  3. Fill in Claim Information:

    • Plan Participation Code (e.g., Assigned - A)

    • Place of Service Code (e.g., Home - 12)

    • Claim Filing Code (e.g., Medicare Part B - MB)

    • Claim Frequency Code (e.g., Original Claim - 1)

  4. Confirm authorizations:

    • Signature on File

    • Benefits Assignment

    • Release of Information Code

  5. Add Prior Authorization if required.

  6. Enter Claim Date Information and any Supplemental Information.

  7. Add Diagnosis Codes:

    • Enter ICD-10 codes

    • Select the appropriate diagnosis type (e.g., ABK - ICD-10CM)
      ​

  8. Upload Documentation if required:

    • Prior authorization approvals

    • Imaging or medical necessity documents

    • Other supporting files

  9. Enter Service Lines:

    • Service Date (start and end if applicable)

    • Procedure Identifier and Procedure Code (e.g., HCPCS or CPT)

    • Measurement Unit (e.g., UN for units)

    • Service Unit Count

    • Total Charges

    • Procedure Modifiers (if applicable)

    • Diagnosis Code Pointers (link procedures to diagnoses)

  10. Repeat for all service lines.

  11. Assign Ordering Provider if applicable.

  12. Review all fields and click Resubmit Claim.

Important Notes

  • Always double-check claim details against the demo file and payer rules before resubmission.

  • Submitting incorrect data can delay reimbursement and increase denial rates.

  • Claims marked Unknown Payer must be corrected before resubmission.

Tips for Efficiency

  • Use filters in the claims list to quickly locate priority claims (e.g., Denied or Pending).

  • Maintain a standard checklist when reviewing claims to avoid missing key fields.

  • Upload supporting documentation during resubmission to reduce back-and-forth with payers.

  • Track correlation IDs and control numbers for faster support when contacting payers.

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