Identifying Rejected Claims with the ConnectCenter

Introduction

As part of visit capture and submitting billing with Sandata Electronic Visit Verification^TM (“EVV”), users have been enrolled in Change Healthcare Exchange ConnectCenter to be able to review their rejected or incomplete claims before correcting and resubmitting them in EVV for for payment.

As claims are processed in the system, they will have a status assigned to them. This status lets you know if the claim is being processed successfully, or if it will require correcting.

Claims can have the following statuses:

Claim Status	Definition
Acknowledged	The claim was received by CHC.
Accepted	The claim is accepted for adjudication - it contains all the required information to send to the payer
CHC Rejected	The claim is not accepted for adjudication because it is missing something required, like the DOB or the Start of service time, or diagnosis code.
Payer Rejected	The information in the claim is wrong and they can't process it, for example the payer doesn’t have a client with that name in their files.
Denied	All or part of the claim was denied and there will be a reason provided.
Request for Information	There is inadequate information provided to process the claim. Information about what is required will be provided.
Pended	A claim is pended when there is missing information the payer is seeking in order to make a coverage decision, such as they are asking questions about alternative coverage, i.e. they think they may not be the primary payer for the client.
Unknown	The Payer status of the claim is unknown.