A payer's email might say a claim was rejected or denied — these are two different things, and Careswitch shows them as two different claim statuses on the invoice group. How you handle each is different, so start by checking which one it is.
"Submission error" (rejected)
The clearinghouse or payer bounced the claim before it could be paid — almost always a data or format problem (missing or invalid info, member eligibility couldn't be confirmed).
What to do: a submission error means something on the billing or submission setup needs correcting, and that's something Careswitch handles. Contact support and we'll look into it. Once we've resolved the issue, you can Resubmit to Payer from the invoice group.
"Payment issue" (denied)
The payer reviewed (adjudicated) the claim and paid nothing. The remittance (ERA) explains why.
What to do: denials can be worked a couple of ways. If you're comfortable handling it yourself:
Correct and resubmit. In the Actions ⋯ menu choose Unlock for Correction, fix the underlying shift details, then click Resubmit to Payer. It goes back out as a replacement that supersedes the denied claim, so the claim history stays intact.
Write it off. If you billed more than the payer authorized and don't expect to collect the rest — even on a resubmission — use Add Adjustment to write off the remaining balance.
Denials can also get involved. If your Paradigm billing/collections contact is already working the claim, they may handle the correction for you.
Before you void or adjust: what these actions do
A few actions in the Actions ⋯ menu change the claim or invoice in ways worth understanding first:
Unlock for Correction reopens a submitted claim so you can edit it. It voids the submitted claim and releases its shifts back to Billable so you can change them; your next Resubmit to Payer then goes out as a replacement of the original. Nothing is lost — the shifts are simply freed up to be corrected and rebilled.
Mark Void cancels the claim. If it had already reached the payer, Careswitch also sends a void to cancel it on their side. The shifts come off the claim and return to Billable, so you can rebill them later if needed. Use it when the claim shouldn't have gone out, or shouldn't be billed at all.
Add Adjustment writes off some or all of the outstanding balance. It does not change what you originally billed and does not send anything to the payer — it just settles the balance on your side. When a write-off brings the balance to zero, the invoice group shows as Paid. Adjustments only become available once the ERA has arrived, and they can't be undone — so use one when you've decided not to pursue the rest of the payment.
One timing note
While a claim is waiting on the payer's ERA, editing is locked ("Waiting for the ERA before invoice can be edited"). Adjustments become available once the ERA arrives.
Where to look
In the sidebar, go to Billing → Invoices and open the flagged invoice group. The status badge reads Submission error or Payment issue, and a red alert at the top spells out the reason. The Resubmit to Payer (or Submit to Payer) button is the main button; the other actions sit under the Actions ⋯ menu.
FAQ
Rejected vs. denied — what's the difference?
Rejected = the claim bounced before payment, usually a submission problem — contact support and we'll fix it, then you resubmit. Denied = the payer reviewed it and paid nothing — read the ERA reason, then either correct and resubmit, or write off the balance.
What happens if I miss a shift that was part of the billing period?
It just goes onto a new claim for the same billing period. Once the original claim has been submitted, that invoice group is locked, so any shift you bill afterward starts a fresh claim for the same period — you can submit it on its own without touching the claim you already sent.
I billed more than the payer authorized — how do I write off the difference?
Once the ERA is in, use Add Adjustment on the invoice group to write off the unpaid balance you don't expect to collect. It settles the invoice on your side (the invoice group shows as Paid when the balance reaches zero) and doesn't resend anything to the payer. Reserve it for amounts you've decided not to pursue further, since adjustments can't be undone.