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.
Before you submit: the review dialog
When you click Submit (or Resubmit) on a claim, Careswitch first shows a Review Claim Before Submitting dialog. Three kinds of checks can appear there, and they behave differently:
Days of service with missing shifts — a hard stop. If a day has other shifts for the same service that aren't on this claim, the dialog lists those days and shifts, and you can't submit until you add every shift for the day to the claim or take it out of billing. A day of service is billed all at once because splitting it across two claims is a common cause of duplicate-claim denials.
Dates already billed on another claim — a hard stop. If a date and procedure code on this claim were already sent to the payer on another claim for the same service, the dialog lists each one with the invoice it's already on, that invoice's status, and what was paid. A second claim for a date the payer has processed comes back denied as a duplicate, so take those dates off this claim, or void the claim that already carries them, before submitting.
Payer mismatch — a warning. On Medicaid claims, Careswitch compares the payer on the claim with the payer named in the client's latest Medicaid eligibility check, and with the payer the claim's visits were recorded under in EVV. If either differs, the dialog shows which payer each source lists and, for EVV, which shifts are affected, with a link to the client's eligibility and policies. You can still choose Submit Anyway — but a mismatch usually means the client's policy needs a look before you do.
"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 from the invoice group.
Submission errors are recorded in the invoice group's Activity as Claim issue entries showing when they were reported. If you dismiss an error from the screen, the dismissal is recorded too — with who dismissed it and what the error said — and the error stays dismissed unless a new failure occurs.
"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. 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.
Move the unpaid dates to a new claim. If the payer paid some dates and denied or left others unpaid, you don't have to correct the whole claim — see Moving unpaid dates to a new claim below.
Denials can also get involved. If your Paradigm billing/collections contact is already working the claim, they may handle the correction for you.
If the payer later pays a denied claim: sometimes a payer re-adjudicates and pays a claim it first denied. When that ERA arrives, Careswitch's reconciliation moves the invoice group from Payment issue to Paid or Partially paid on its own — you don't need to resubmit. (Manually marking a denied third-party claim as paid isn't available; the status follows the remittance.)
Moving unpaid dates to a new claim
When a claim comes back Partially paid — or Paid or Payment issue with some dates the payer didn't pay — you can take just the unpaid dates off it and bill them on a new claim, under the same authorization or a different policy of the client. The original claim keeps its paid dates and its adjudication history untouched.
This is available once the payer's ERA has been received for the latest claim and the invoice group is settled (Paid, Partially paid, or Payment issue). You need permission to manage billing. Dates the payer has paid stay locked to the claim they were paid under and can't be moved.
Go to Billing → Invoices and open the invoice group.
In the claim's line items, tick the checkbox on each unpaid line you want to move. (Paid dates have no checkbox. Ticking one shift ticks its whole line.)
Click Move to another claim, which appears once something is selected.
On the Move to Another Claim page, choose what to Bill under. Keep the current policy (marked (current)) to re-bill the same authorization, or pick another of the client's policies that covers those dates — for example, when the dates belong under a different authorization. Changing the policy re-bills whole shifts, so it's only offered when every billed date of the shifts involved is selected and none of them sits on another invoice; otherwise the other policies are disabled with a note explaining why. If you do change policy, a Policy change notice confirms which payer the new claim goes to.
Enter a Reason. It's required and is recorded on both claims.
Read the What happens summary — the moved dates go onto a new invoice and are submitted as a new claim, not a correction, and the original invoice is re-totalled to what stays on it — then click Move to another claim.
Submit the new claim as usual. Before it goes out, the review dialog checks that none of its dates were already billed on another claim (see Before you submit), and the correction stays tied to the policy the original claim used unless you chose a different one.
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 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.
When an ERA reverses an earlier payment and issues a corrected payment for the same claim, both show in the invoice group's Activity: an ERA payment reversed entry (with the amount, date, and EFT trace or check number) and a New ERA payment entry.
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 (or Submit, for a claim that has never been sent) 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.
Why won't Careswitch let me submit — "Days of service with missing shifts"?
One or more days on the claim have other shifts for the same service that aren't on it yet. Add those shifts to the claim (or take them out of billing if they shouldn't be billed) and submit again. Splitting one day's service across two claims tends to come back as a duplicate-claim denial, so Careswitch blocks it up front.
Why won't Careswitch let me submit — "Dates already billed on another claim"?
At least one date and procedure code on this claim was already sent to the payer on another claim for the same service, and the payer would deny the second one as a duplicate. The dialog shows which invoice already carries each date. Either take those dates off this claim, or — if the other claim is the one that's wrong — void it first, then submit.
The payer paid some dates and denied others. Do I have to redo the whole claim?
No. Once the ERA is in, tick the unpaid lines on the invoice group and click Move to another claim. The unpaid dates go onto a new claim (under the same authorization, or a different policy if you choose one), and the original claim keeps its paid dates and history. See Moving unpaid dates to a new claim.
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. (The one exception is a shift from a day that's already on the submitted claim — see the previous question.)
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.