Resetting a claim to unbilled



I am working on my billing. There are a few claims that I sent to the incorrect insurance company. I sent it to the secondary first (inadvertently). I have reopened the claims by going to the fee sheet of each claim and using the “Undo checkout and reopen” button.

Now, will this set the claim back to be sent to the primary insurance or will it still be queued as secondary?

Also, when generating the x12 files, I am having difficulty understanding this phrase:

“Validate and Clear: validates then sets claims status only, to billed, leaving billing process unaltered and claim submission resets to resubmitted.”

Any help is greatly appreciated.

I haven’t dived into the code much and could be wrong about all this, but for your first question, we use the “done with” setting in the EOB Posting page combined with “Mark as Cleared” in the billing manager to reset to primary. I think the “Undo checkout and reopen” button relates to the encounter/fee sheet, not the claim. Not sure what effect if any it has on the billing status.

Regarding “Validate and Clear”, there is a thread on here where that is discussed, but not sure it has been fully explained. We don’t use it, but have interpreted it to mean that it replicates what would happen if you combined the steps of “Validate only” on the claims, then a “Mark as Cleared” on all of them. Perhaps the utility of that is when you want to check the batch file but know you won’t want to submit the actual X12 produced?

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I think I finally got it.

Validate, checks claims for errors (no batch created)
Clear, sets the claim status as billed
Continue: Validates, clears and creates batch (which is saved in the openemr>sites>default>documents>edi directory)

Yes, it does make sense, I am not sure why it has been hard for me to understand.