Submit a claim to a medical insurer

You send a claim from an invoice you've already finalised. Practor checks it before sending. ## Enrol each practitioner before their first claim A claim gets sent under the treating practitioner's own registration, so you enrol each practitioner separately. Any staff member can do it, on the practice's behalf. 1. Open your practice settings and go to **Insurance**, under **Billing**. 2. Find the practitioner in the list and press **Enrol**. 3. Fill in their registration details and submit. The list counts how many are enrolled and shows each practitioner's status. Until one is enrolled, their invoices and the patient's billing tab show a panel instead of the submit button. | What the panel says | What to do | | --- | --- | | Not enrolled for insurance claims | Press **Enrol for insurance claims** | | Enrolment under review | Wait for approval. **View enrolment status** shows where it is | | Enrolment couldn't be processed | Press **Re-enrol** and check the numbers you entered | | Enrolment ended | Press **Re-enrol** |  ## Send the claim 1. Open the finalised invoice and press **Submit to insurance**. It's on the invoice itself, and on the **Claims** tab until the first claim gets sent. 2. If the patient has more than one cover, pick the one to claim against. The checks re-run each time you change it. 3. Under place of service, pick where you saw the patient. 4. Press **Submit claim**. Practor opens the **Claims** tab and the claim starts as **Submitting**. ## Clear every check before Practor will send The sheet has a **Claim readiness** panel. It reads **Ready** when the claim can be sent, and counts the problems until then. **Submit claim** stays greyed out until all four groups pass, and each failing line says what to do. | Group | What it wants | Where to fix it | | --- | --- | --- | | Invoice details | A finalised invoice whose lines all have a procedure code, a code system, a primary diagnosis and a diagnosis code in the right format, with no codes that can't be billed together and no claim already running | The invoice | | Coverage & insurance | Cover recorded against the patient, and their eligibility verified | The patient's billing details, which [Record how a patient's visits are paid for](/help/patients-and-records/record-how-a-patient-pays) covers | | Practice configuration | The member number, the plan's option code, your practice number and the practitioner's registration number | The patient's cover, and your practice settings | | Insurance enrolment | The practitioner enrolled, against the practice number you're using now | Practice settings, under **Insurance** |  If you change your practice number, claims stop until you enrol again. The check reads **Practice number changed since enrolment: re-enrolment required**. If the invoice changed since the checks ran, Practor refuses the claim and tells you what failed. ## Read what comes back | Status | What it means | | --- | --- | | Submitting | Sent, waiting on the insurer | | Accepted | The insurer took the whole claim | | Partially accepted | Some lines went through and others didn't | | Rejected | The insurer declined it, with a reason | | Reversing | Your withdrawal is on its way | | Reversed | The claim is withdrawn, and you can send a corrected one | | Reversal failed | The withdrawal didn't take. Press **Reverse claim** again | Each line comes back as **Processed**, **Warning** or **Rejected**, so a partially accepted claim shows which line to look at. Press a row on the **Claims** tab to open its lines. ## Send a corrected claim You can resend a claim the insurer rejected, and one you withdrew yourself. A partially accepted claim can't be resent, because that would bill the accepted lines twice: withdraw it first. 1. Go to the **Claims** tab on the invoice. 2. Hover the claim's row and press the actions button at its end. 3. Press **Resubmit claim**. 4. If the patient has more than one cover, pick the one to claim against. It starts on the one the claim went to before. 5. Check the place of service. 6. Press **Resubmit claim**. It sends from the same invoice, so fix the invoice before you resend. ## Withdraw a claim the insurer accepted Do this when the visit was billed wrongly. You also have to do it before you can amend the invoice. 1. Go to the **Claims** tab and hover the claim's row. 2. Press the actions button, then **Reverse claim**. | What stops you amending | What to do | | --- | --- | | Reverse the claim before amending | Reverse it, then amend | | Claim is in-flight: wait for it to settle | Wait for the answer | | Claim reversal failed: resolve it before amending | Press **Reverse claim** again | ## Cancel a claim that is stuck You can cancel a claim that sits on **Submitting** or **Reversing** for several minutes with no answer. 1. Hover the row and press the actions button. 2. Press **Cancel pending submission**, or **Cancel pending reversal** if it was a withdrawal. 3. Confirm with **Cancel submission**, or **Cancel reversal** on a withdrawal. **Keep waiting** leaves it alone. > [!WARNING] > This only unsticks the invoice on your side so you can submit, resubmit or reverse again. It does not recall a request the insurer has already accepted. ## Related - [Create and send an invoice](/help/billing-and-claims/create-and-send-an-invoice) - [Set what you charge on an invoice](/help/billing-and-claims/set-what-you-charge-on-an-invoice) - [Add a patient](/help/patients-and-records/add-a-patient)