If a payer tells you a claim was rejected or denied, start by checking its status in Careswitch. These terms mean different things, and each has its own next steps:
Submission error means the claim was rejected before it could be paid.
Payment issue means the payer reviewed the claim and denied payment.
You'll see these statuses on the invoice group.
Before you submit: review your claim
When you click Submit or Resubmit, Careswitch opens the Review Claim Before Submitting dialog. It checks for issues that need to be resolved before submission and warnings you can review before continuing.
Issues that prevent submission
You must resolve these issues before you can submit the claim:
Missing information. The claim is missing information the payer requires, such as diagnosis codes, a prior authorization number, the EDI payer ID, or billing provider details. The dialog lists each missing item. Add the information, then try submitting again.
Days of service with missing shifts. A day included on the claim has other shifts for the same service that haven't been added. The dialog lists the affected days and shifts. Add every shift for that day to the claim, or remove any shifts that shouldn't be billed from billing. A day's service must be billed together because splitting it across two claims commonly leads to duplicate-claim denials.
Dates already billed on another claim. A date and procedure code on this claim have already been sent to the payer on another claim for the same service. The dialog shows each affected date, the invoice it appears on, that invoice's status, and the amount paid. The payer denies a second claim for a date it has already processed as a duplicate. Remove those dates from this claim, or void the claim that already includes them, before submitting.
Warnings to review
These warnings help you check your claim before sending it:
Shifts not added to this invoice. Some shifts in the billing cycle haven't been added to this claim. Completed shifts and scheduled shifts are listed separately. Review them to decide whether any should be billed now.
Authorization overage. The claim exceeds the authorization limit for the period. The dialog shows the amount billed against the limit and how much this claim contributes to the overage. Payers usually won't pay amounts above the authorization, so you may want to adjust the claim before submitting.
Payer mismatch. For Medicaid claims, Careswitch compares the claim's payer with the payer in the client's latest Medicaid eligibility check and the payer used to record the claim's visits in EVV. If either differs, the dialog shows the payer listed by each source. For EVV mismatches, it also lists the affected shifts. A link takes you to the client's eligibility and policies. Review the client's policy before submitting when you see a mismatch.
If there are issues preventing submission, the dialog shows those first. After you resolve them, any warnings appear the next time you try to submit. When only warnings remain, you can select Submit Anyway.
Careswitch never automatically submits a claim with a payer mismatch. These claims wait for someone to review them.
EVV issues that prevent billing
If a shift requires electronic visit verification (EVV), Sandata must accept the visit before you can bill it on a claim.
Check the shift’s EVV status in Billing → Items or in the invoice group’s line items.
What the EVV badge means
Accepted. Sandata accepted the visit. The shift is ready to bill.
Pending. The visit is being sent to Sandata or is waiting for a response. Careswitch automatically retries temporary errors. Wait for the badge to show Accepted before billing the shift.
Rejected. Sandata rejected the visit, or a data error is preventing it from being sent. You must fix the issue before billing. See Fixing a rejected EVV visit below.
Not sent. This shift does not require EVV, so EVV does not affect billing.
EVV issues that stop a claim
When you submit a claim, Careswitch checks every shift that requires EVV. If any check fails, the claim is not sent.
The error message identifies the affected shift. A Claim issue entry also appears in the invoice group’s Activity. Fix each issue, then select Submit again.
Unacceptable EVV status. Sandata has not accepted the visit. The message shows its current status, such as Awaiting Sandata response or Rejected. If the visit is pending, wait for it to be accepted. If it was rejected, fix the issue before submitting again.
Missing EVV submission data or EVV hours. Careswitch cannot find the visit details or hours accepted by Sandata. Open the shift and check its EVV status. If it was rejected, fix the issue and retry it. Contact support if you cannot tell what is missing.
Claim hours exceed EVV hours. The shift’s billed hours are more than the hours Sandata accepted. Payers usually deny the extra hours. Update the shift’s billable time to match the recorded clock-in and clock-out times. If the clock times are wrong, correct them.
Date of service doesn't match the EVV visit. The date billed on the claim is different from the visit date Sandata recorded. This often happens when a shift crosses midnight. The payer will deny the line with reason code CO-272/N473. Update the shift’s billable time to match the recorded clock-in and clock-out times, then submit again.
Fixing a rejected EVV visit
Open the shift and review the error in the EVV section of the shift’s details.
If you see Sandata rejected the caregiver's record or Sandata rejected the client's record, the visit itself is not the problem. Follow the error message to correct the caregiver’s or client’s record. The visit is sent once Sandata accepts that record.
If you see Sandata rejected this visit, review the error and correct the shift’s details.
Go to Billing → Items, find the shift, and select Retry EVV to send the visit to Sandata again. You need permission to manage billing. Retry EVV only appears when the visit is rejected, blocked by a data error, or retrying.
Wait for the badge to show Accepted. You can then add the shift to a claim or submit the existing claim again.
Contact support if the error is unclear or the visit keeps being rejected.
Submission error: a rejected claim
A Submission error means the clearinghouse or payer rejected the claim before it could be paid. This is usually caused by a data or format issue, such as missing or invalid information, or member eligibility that couldn't be confirmed.
What to do: contact support so we can review and correct the billing or submission setup. Once the issue is resolved, select Resubmit from the invoice group.
Submission errors appear in the invoice group's Activity as Claim issue entries, with the time they were reported. If you dismiss an error, Activity also records who dismissed it and the error message. The error stays dismissed unless a new failure occurs.
Payment issue: a denied claim
A Payment issue means the payer reviewed, or adjudicated, the claim and paid nothing. The electronic remittance advice (ERA) explains the reason.
What to do: review the ERA and choose the next step that fits the situation. If you're comfortable managing the denial yourself, you can:
Correct and resubmit. Open Actions ⋯, select Unlock for Correction, and correct the underlying shift details. Then click Resubmit. Careswitch sends a replacement claim that supersedes the denied claim while preserving the claim history.
Bill the correct payer or policy. If the claim was sent under the wrong payer or policy, select Void & release shifts from Actions ⋯. This voids the claim in Careswitch without sending anything to the payer. The shifts become available for billing again so you can bill them under the correct payer or policy.
Write off the remaining balance. If you billed more than the payer authorized and don't expect to collect the rest, including through resubmission, use Add Adjustment. You can also bill the written-off amount to a private-pay payer on a new invoice. See “Before you void or adjust: understand your options” below.
Move unpaid dates to a new claim. If the payer paid some dates but denied or left others unpaid, you can move just the unpaid dates instead of correcting the entire claim. See "Moving unpaid dates to a new claim" below.
Some denials need a more detailed review. If your Paradigm billing/collections contact is already working on the claim, they may handle the correction for you.
If the payer later pays a denied claim: a payer may review a denied claim again and issue payment. When the new ERA arrives, Careswitch automatically reconciles the payment and updates the invoice group from Payment issue to Paid or Partially paid.
You don't need to resubmit. You can't manually mark a denied third-party claim as paid; its status follows the remittance.
Moving unpaid dates to a new claim
If a claim has a status of Partially paid, Paid, or Payment issue and includes dates the payer didn't pay, you can move those unpaid dates to a new claim. You can use the same authorization or another of the client's policies. The original claim keeps its paid dates and adjudication history.
This option is available after the ERA for the latest claim has arrived and the invoice group is settled with a status of Paid, Partially paid, or Payment issue. You need permission to manage billing. Paid dates 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, select the checkbox for each unpaid line you want to move. Paid dates don't have a checkbox. Selecting one shift selects its entire line.
Click Move to another claim. This button appears after you make a selection.
On the Move to Another Claim page, choose what to Bill under:
Keep the existing policy, marked (current), to bill the same authorization again.
Choose another of the client's policies that covers the selected dates, such as when the dates belong under a different authorization.
Changing the policy bills whole shifts again. This option is available only when all billed dates for the affected shifts are selected and none of those dates appear on another invoice. Otherwise, the other policies are disabled, with a note explaining why. If you change the policy, a Policy change notice confirms which payer will receive the new claim.
Enter a Reason. This is required and is recorded on both invoices.
Review the What happens summary, then click Move to another claim. The summary explains that:
The selected dates move to a new invoice and are submitted as a new claim rather than a correction.
The original invoice total is updated to include only the dates that remain. If those dates have all been paid, the invoice shows as paid in full.
Nothing is sent again to the payer for the original claim.
Submit the new claim as usual. Before submission, the review dialog checks that none of its dates were already billed on another claim. The new claim uses the policy you selected on the Move page.
Before you void or adjust: understand your options
The Actions ⋯ menu includes several ways to manage a claim or invoice. Here's what each action does:
Unlock for Correction reopens a submitted claim so you can edit its shifts. Careswitch prepares a corrected claim for you to edit. The original claim keeps its status until you resubmit. When you select Resubmit, the corrected claim is sent as a replacement for the original.
Reopened status: When you unlock a claim for correction, its invoice shows Reopened instead of Open in the Invoices list, the payer’s Invoices tab, the invoice page, and the Status filter. This label identifies an invoice that was previously billed and is now being corrected. It is removed when you resubmit the corrected claim or select Cancel Correction.
Cancel Correction removes a correction you no longer need. It discards the correction, locks the line items again, and returns the invoice to its previous status. This option is available only if you haven't changed any line items since unlocking. If you've made changes, resubmit the corrected claim or undo your changes first.
Void & release shifts cancels the claim in Careswitch without sending anything to the payer. Use this for a denied, rejected, or unsubmitted claim when the payer holds no money. The shifts become available for billing under the correct payer or policy. If any dates were paid on an earlier claim, those dates remain on this invoice and aren't billed again.
Send void to payer cancels a claim that the payer has already paid or partially paid by sending a void to the payer. Paid dates remain on the voided invoice and aren't billed again. Unpaid dates become available for billing. This action requires the payer's claim control number from the ERA. It isn't available while the claim is unlocked for correction; cancel the correction or submit the corrected claim first.
Add Adjustment writes off part or all of the outstanding balance. Enter an amount up to the remaining balance and a reason. This doesn't change the amount originally billed or send anything to the payer; it settles the balance in Careswitch. If the write-off brings the balance to zero, the invoice group shows as Paid. To collect that amount from someone else, such as the client or family, turn on Bill Adjustment To New Invoice? and select a private-pay payer. Careswitch creates a new invoice for the adjustment amount. Adjustments are available only after the ERA arrives and can't be undone. Use an adjustment once you've decided not to pursue the remaining payment from this payer.
Both void actions ask you to select a reason.
When you can edit a claim
Editing is locked while a claim is waiting for the payer's ERA. You'll see “Waiting for the ERA before invoice can be edited.” Until the ERA arrives, Unlock for Correction, Send void to payer, and Add Adjustment are unavailable.
If an ERA reverses an earlier payment and issues a corrected payment for the same claim, both appear in the invoice group's Activity:
ERA payment reversed, including the amount, date, and EFT trace or check number.
New ERA payment.
Where to find claim details and actions
In the sidebar, go to Billing → Invoices and open the flagged invoice group. The status badge shows Submission error or Payment issue, and a red alert at the top explains the reason.
To find invoices being corrected, go to Billing → Invoices and select Reopened in the Status filter.
The main button is Resubmit, or Submit if the claim hasn't been sent before. You'll find the other options in Actions ⋯.
FAQ
What's the difference between a rejected and a denied claim?
A rejected claim wasn't accepted for payment, usually because of a submission issue. Contact support so we can resolve the issue, then resubmit. A denied claim was reviewed by the payer, but no payment was issued. Review the reason in the ERA, then correct and resubmit, void and bill under the correct payer or policy, or write off the balance.
Why can't I submit a claim with “Missing information”?
The claim is missing information the payer requires. The review dialog lists each missing item. Add the information, such as on the client's policy or in the payer setup, then try submitting again. If you're unsure where to enter it, contact support.
Why can't I submit a claim with “Days of service with missing shifts”?
One or more days on the claim have other shifts for the same service that haven't been included. Add those shifts to the claim, or remove them from billing if they shouldn't be billed. Then try submitting again. Careswitch prevents a day's service from being split across claims because this commonly causes duplicate-claim denials.
Why can't I submit a claim with “Dates already billed on another claim”?
At least one date and procedure code on this claim have already been sent to the payer on another claim for the same service. The payer would deny the second claim as a duplicate. The dialog shows which invoice includes each date. Remove those dates from this claim. If the other claim is incorrect, void it before submitting this one.
If the payer paid some dates and denied others, do I need to redo the whole claim?
No. Once the ERA has arrived, select the unpaid lines on the invoice group and click Move to another claim. You can move them to a new claim under the same authorization or choose a different policy. The original claim keeps its paid dates and history.
How do I undo Unlock for Correction if I don't need to make changes?
Select Cancel Correction from Actions ⋯. The invoice returns to its previous status. This option is available only if you haven't changed any line items since unlocking.
What happens if I missed a shift from the billing period?
The shift is added to a new claim for the same billing period. After the original claim is submitted, its invoice group is locked, so shifts billed later create a new claim for that period. You can submit the new claim separately without changing the one already sent.
The exception is a shift from a day already included on the submitted claim. See “Days of service with missing shifts” above.
How do I write off an amount billed above the payer's authorization?
Before submission, the review dialog displays an Authorization overage warning so you can review the amount. If the claim has already been submitted and the ERA has arrived, use Add Adjustment on the invoice group to write off the unpaid balance you don't expect to collect.
This settles the balance in Careswitch without sending anything to the payer. The invoice group shows as Paid when the balance reaches zero. If the client or family should pay the difference, turn on Bill Adjustment To New Invoice? to create a new private-pay invoice for that amount.
Adjustments can't be undone, so use them only for amounts you've decided not to pursue with this payer.
Why can't I bill a shift with a Pending EVV badge?
Sandata must accept the visit before you can bill it. Wait for the badge to show Accepted.
If the visit stays pending for a long time, open the shift and check the EVV section. It may be waiting for a caregiver’s or client’s record that Sandata rejected.
Why does the EVV badge say Rejected when the visit looks correct?
The badge also turns red when Sandata rejects the caregiver’s or client’s record linked to the visit. Open the shift to see which record was rejected and why.
When should I use Retry EVV?
Use Retry EVV after fixing the problem that caused the rejection. Retrying without fixing the issue usually results in the same rejection.
Can I submit a claim with an EVV warning instead of an error?
Yes. A payer mismatch warning asks you to review the claim but does not stop you from submitting it. If the claim is correct, select Submit Anyway.
The errors listed above do stop the claim. You must fix them before submitting.