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A claim asks an insurer to pay for care you have already delivered. Insurance Claims is your hospital’s claim register: you prepare each claim here, send it to the payer the way you already do, and track its answer. Nothing is transmitted electronically to a clearinghouse from this screen — knowing that up front saves waiting for a transmission that will not happen.

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What you’re looking at

The heading reads Insurance Claims with your hospital’s name beneath it, and a refresh button and New Claim beside it. A row of tiles sits above the tabs: Total Claims, Approval Rate, Total Claimed, Total Approved, Total Paid, Pending Claims, Denied Claims and Pending Appeals. Three tabs, each answering a different question: The list carries Claim #, Patient, Type, Service Date, Insurance, Amount, Approved, Status and Actions — Amount is what you billed, Approved is what the payer allowed, and the gap between them is your write-off or your appeal. Above it, search on “Search by claim number or notes…” and filter by status, by type (Outpatient, Inpatient, Emergency, Pharmacy, Laboratory, Radiology) and by company. Empty state. With nothing raised, or a filter matching nothing, the list reads No claims found. Opening a claim that has been removed shows Claim not found with a Back to Claims button.

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The statuses

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Prepare the claim

The claim form opens as tabs you work through in order.
1

Create the claim

Select New Claim.
2

Basic Info

The patient, the encounter and the dates. This is what ties the claim to the care that was actually delivered, and it is what a payer checks first.
3

Items & Services

Every service, medicine and consumable you are billing for. Prices come from the payer-specific rates on the Pricing tab of the Insurance dashboard, not from your standard fees.
4

Insurance & Diagnosis

The insurer, the patient’s cover, and the diagnosis codes that justify every item. If the form says No insurance information on file, select Add Insurance and complete the Add Insurance Details dialog. An item with no supporting diagnosis is the denial you will spend next month arguing about.
5

Review & Submit

Read the whole claim back, then save it. You are told Claim created successfully! Starting AI analysis…, and an AI Analysis tab appears alongside the others.

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Check it, then submit it

A saved claim is a Draft — nothing has left the building yet.
1

Open the claim

Select it from the Claims list.
2

Run the check

On a draft, AI Review looks for gaps a payer would query. It is a prompt to look again, never a decision, and the claim still moves only when a person moves it. Edit is available while the claim is a draft, and reopens the full CMS-1500 form filled with what was saved, so diagnoses and service lines are corrected with the same code search they were built with. A draft can also be deleted from its detail panel; a claim that has left draft cannot, and shows no delete control.
3

Submit

Select Submit Claim — offered on a Draft or an AI Reviewed claim. You are told Claim submitted successfully and the status moves on.
4

Quote the approval

Where you obtained a pre-authorization, quote it. An approved request is the fastest route through a payer’s review.
Record the payer’s decision when it arrives, and record the money when that arrives. A claim marked paid with nothing reconciled against it is a claim you have not actually been paid for.

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Who can do this

Role Navigation is what decides who gets here. The page itself checks nothing — its old hardcoded role list was retired — so anyone who can reach the Insurance group can prepare, submit and read a claim. Under Settings → Role Navigation accountants and billers reach it by default, alongside owners and managers, and a role with no rule of its own is unrestricted. Your staff sheet’s Billing section does carry File insurance claims, Add insurance payments, Request coverage reports, Edit service fees and View financial dashboard, and they are recorded against each person — but no insurance screen reads them, so they change nothing today. Restrict insurance at the Role Navigation layer instead. Enforcement is opt-in per person: a colleague never saved in the permissions sheet is unrestricted, and the sheet warns “Saving starts enforcing” before that changes. A denied action is recorded; an allowed one is not. Hiding Insurance from a role is a convenience, not a security boundary. No figure on this page is withheld by permission — if you can open Claims you see all of it.

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Check it worked

  • The claim appears on Claims with a Claim #, the payer’s name and a status past Draft.
  • Total Claimed on the tiles has risen by the claim’s amount.
  • Nothing you meant to bill this month is still sitting as a Draft.
  • When money arrives, the claim reads Paid and has a payment recorded against it.

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Common issues

Clear the search box and set the status, type and company filters back to All, then refresh. A Draft is hidden whenever the status filter is set to anything else.
Add the insurer on the Companies tab of the Insurance dashboard, then record the patient’s cover from the claim form.
Payer-specific prices live under Insurance → Pricing. Fix the rate there so every future claim is right, rather than overtyping each one.
It is offered only on a Draft or an AI Reviewed claim. A claim already submitted has nothing to submit; a claim you may not file will not offer it either — see Permissions.
Read their reason against what you submitted. Most denials are a missing supporting diagnosis, a quantity beyond what the plan allows, or an item the cover excludes. Correct the record and re-submit rather than arguing the original.
They are self-paying for that visit. Raise an invoice instead — see Billing. A claim against expired cover is a denial you can see coming.

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FAQ

No. It is prepared and tracked here, and you send it to the insurer the way you already do. Marking it Submitted records that you sent it.
Edit is offered while the claim is a Draft, and reopens the CMS-1500 form with every field it collects — diagnoses, service lines, modifiers, dates and payer — as they were saved. Once it has gone to the payer, correct the record and re-submit rather than quietly changing what they were sent.
Amount is what you billed; Approved is what the payer allowed. The difference is what you either write off or appeal, which is why Pending Appeals has its own tile.
No. It is a check, not a gate — a draft can go straight to Submit Claim. The form works the same without it.
On the Analytics tab for a quick read, and in the Insurance report for volume, denials and aging over a period — see Reports and analytics.