🖥️ For providers using the Oasys web app. This is for providers who bill insurance; to set it up, see Setting up billing.
This article helps you follow an insurance claim after you send it from Bill sessions. It covers claim statuses, units and add-on codes, correcting, resubmitting or voiding a claim, payment remittances (ERAs), eligibility checks, and secondary insurance.
In this article
1. Insurance claims after submission
Track submitted claims in Billing → Manage claims. It has two views:
All claims.
Needs attention: rejected, denied, submission-failed and "needs investigation" claims. The count shows on the tab and on Manage claims in the sidebar.
Use the search box (client name, claim number, or check number) and the Claim status dropdown to narrow the list.
What's on a claim
Open a claim to see four tabs:
Overview: payer, service date, CPT code, Modifiers, Place of Service, diagnosis, prior authorization number, the PCN (Patient Control Number, the claim's own reference number) and, once the payer has it, the Payer Control #. It also shows the client's name, date of birth and member ID, and the money: total charge, allowed amount, payer paid, patient responsibility and balance. A Providers card shows the NPI and Taxonomy sent on the claim for the Billing entity and the Rendering clinician (Not sent if the claim went out without one).
Charges: one row per service line with its procedure code, modifiers, diagnosis, units, charge, allowed and paid amounts.
History: earlier and later versions of the claim (for example, the original and its resubmission).
Payments: the remittance (ERA) details for the claim.
Claim statuses
Each claim shows one of these statuses:
Draft: saved but not yet submitted. Use Submit Claim from its three-dot menu (or Delete Claim).
Submitting: submission is being finalized. Contact Oasys support if this persists.
Submitted: sent to the payer. Wait for acknowledgment (1–2 business days).
Received: the payer or clearinghouse received the claim but hasn't accepted it for review yet.
Accepted: the payer accepted the claim into its adjudication system. This isn't a payment decision, and a claim can sit here for weeks before it's paid. (A code like "277CA" is the acknowledgment report, not a claim number.)
Rejected: the payer or clearinghouse rejected the claim before review, usually because of a data error. Fix and resubmit.
Denied: the payer reviewed and denied the claim. Open the claim to see the denial reason. Correct and resubmit, contact the payer about an appeal, or write it off.
Paid: payment has been received. Details appear in Payment remittances.
Partially paid: the payer paid part of the claim and more payment is expected.
Patient responsibility: the payer assigned some or all of the allowed amount to the client.
Needs investigation: the payer processed the claim with no payment and no client responsibility ($0). Review it.
Submission failed: the claim couldn't be submitted. Correct the problem and retry.
Voided: the claim was voided. A replacement may be resubmitted.
Badges and the Paid column
A Payment failed badge next to a claim's status means the client's card payment for their responsibility invoice didn't go through. Follow up on the invoice in Manage invoices.
The Paid column on Manage claims includes both the insurer's payment and what the client has paid on their responsibility invoice.
2. Units and add-on codes on a claim
A claim carries the session's primary service plus each priced additional service as its own service line, each with its units (for example, 96130 × 1 and 96131 × 2 on one claim). Multiple CPT codes and multiple units are billed electronically on the same claim.
In the claim wizard you see a Primary row and Additional rows.
You can edit each row's CPT code, units (1–24) and modifiers. You can't add or remove rows there; change the session's services instead.
The CPT code lists also include the HCPCS codes H0004, H2000, H2015 and T1016. Choosing one as a claim override doesn't change the service's units, price or modifiers.
Each CPT code can appear only once on a claim. Increase the units instead of adding another line.
A claim holds at most 6 lines (the primary plus 5 additional).
Each row shows its Charge, which doesn't change when you edit its coding.
Free additional services stay on the session but don't become claim lines.
If you use a prior authorization, it must cover every line's CPT code.
To set up additional services on a session, see Additional services and units.
3. Correcting, resubmitting or voiding a claim
Rejected and denied claims can be corrected and resubmitted, and a processed claim can be voided.
Reading why a claim was rejected or denied
Rejected, denied and failed claims collect in Billing → Manage claims → Needs attention. Each needs a different fix.
Submission failed: the claim never left Oasys. Fix the problem shown, then delete the claim and bill the session again.
Rejected: the payer or clearinghouse turned the claim away before reviewing it, usually because of a data error. Correct the data and resubmit.
Denied: the payer reviewed the claim and decided not to pay. If it was a coding or data mistake, correct it and resubmit. If you disagree with the decision, appeal with the payer directly. Oasys doesn't file appeals.
Open the claim to see why. The status card shows:
Rejection Codes, Denial Codes or, for a failed submission, Error Details. Click a code to copy it.
What to Do: suggested fixes, when Oasys recognizes the code.
Explain Error (rejections and denials only): a plain-English explanation of what happened and how to fix it.
Resubmitting a rejected or denied claim
Open the claim and click Resubmit Claim. The Edit & Resubmit Claim dialog opens.
Make your corrections, then click Preview Corrections to check them.
Click Apply & Resubmit.
If no editable fields were identified, you can still resubmit the claim as it is.
Corrections such as the member ID or your NPI are saved back to the client's insurance details or your provider information, so later claims use them too. Check the client's insurance details before resubmitting.
Once a claim has been resubmitted, its button shows Resubmitted ("This claim has already been resubmitted").
If a claim failed at the clearinghouse (Submission failed), the claim page tells you to fix the issue shown, then delete the failed claim and create it again.
⚠️ Important: If you've already sent the client a responsibility invoice for the claim, void that invoice before you resubmit the claim.
Common rejection causes and where to fix them
Fix the data where it lives, so the next claim goes out right too.
The reason mentions | Where to fix it |
Member ID, subscriber or group number | The client's insurance. Check it against their card, then run an eligibility check. |
Client or subscriber date of birth or sex | The client's insurance (client and subscriber steps). If a subscriber other than the client is selected, fill in every subscriber field. |
Address or ZIP code | The client's address in their insurance. It must be a valid US address, and for most claims not a PO Box. |
NPI, taxonomy or tax ID | Billing → Billing setup → Provider information. |
Diagnosis code | The diagnosis in the client's chart. Use a current, billable ICD-10 code. |
Payer | The client's insurance. See Payer not found, or claims going to the wrong payer. |
When you can't resubmit
Oasys explains why Resubmit Claim isn't available. The most common reasons:
A responsibility invoice was already sent to the client: void that invoice first.
The client's responsibility was marked as paid externally: undo the external payment first.
The claim has no Payer Claim Control Number (PCCN) yet: wait for the payer to acknowledge the claim, then try again.
The claim has already been resubmitted: open the newer version instead. A replacement shows a Resubmission badge.
The session is waived or has no price or CPT code: fix the session's pricing first.
Voiding a claim
Voiding withdraws a claim from the payer. It sends a cancellation to the clearinghouse and can't be undone.
Open the claim and click Void Claim.
Enter a Reason for voiding.
Click Void Claim to confirm (or Keep Claim to back out).
A claim can't be voided until the payer has processed it. If the payer control number is missing, try refreshing the claim's payment status.
You can't void a claim while the client's responsibility for it is still live. First void or refund the patient responsibility invoice, or undo the external payment if you logged one. Void Claim stays visible and explains what to do.
A voided claim leaves nothing for the client to pay. You can't bill patient responsibility from it or mark that responsibility as paid.
4. Payment remittances (ERAs)
When an insurance payer processes your claim, they send an ERA. View it in Billing → Payment remittances (All Remittances and Archived tabs). Each ERA shows:
Payer name, check/EFT date, and check number.
Total payment amount and number of claims.
A claim-by-claim breakdown: billed, allowed, paid, and client responsibility.
Units submitted and paid on each service line. If the payer didn't send the submitted units and Oasys can't match them to a claim line, you'll see Unavailable.
Adjustment codes and reasons.
If the ERA shows client responsibility, create an invoice for the client's share with Bill patient responsibility from the claim's three-dot menu in Manage claims. If auto-billing is on, this happens automatically.
Matched or Unmatched
An ERA claim line shows as Matched (tied to one of your claims) or Unmatched.
Unmatched remittances stay on your remittance list. Oasys doesn't match them to a claim for you, and they aren't counted toward your income.
Occasionally a client's copay is auto-billed slightly before the ERA appears in this tab. That's a short posting lag, not a lost remittance.
Entering a payment by hand (no ERA)
Use this when a payer never sends an electronic ERA (for example, a paper remittance or a third-party administrator).
Open the claim in Manage claims and open its three-dot menu.
Choose Mark claim paid manually.
Enter the EOB details: insurance paid, allowed amount, deductible, coinsurance, copay, check number, and date.
This is available on claims that are Submitted, Received, or Accepted with no ERA and no payment posted yet. If an ERA later arrives for that claim, you'll need to reconcile the two by hand.
To record a denial from a paper EOB, enter $0 for insurance paid, allowed amount, deductible, coinsurance and copay. The dialog changes to Record payer denial: the check number becomes optional and the date is the EOB date. Click Record denial. The claim is marked Denied, so you can correct and resubmit it. To reverse the entry, choose Undo denial; this isn't available once a replacement claim has been created.
💡 Tip: Two "paid" actions are easy to confuse:
Mark claim paid manually logs the insurer's payment (the manual EOB above).
Mark externally paid logs that the client paid their patient-responsibility balance to you directly, outside Oasys. If a responsibility invoice is already open, void it first. To reverse it, use Undo external payment.
Correcting a manual insurance payment
There's no direct edit. To fix a wrong amount:
Void the patient-responsibility invoice tied to the claim.
Choose Undo manual payment on the claim.
Choose Mark claim paid manually again with the correct figures.
Re-bill the client's responsibility if needed.
5. Running eligibility checks
You can verify a client's insurance coverage yourself. Any clinician can run a check; you don't need to route it through a billing admin. Run one from the insurance wizard (Verify Eligibility), or any time:
From Billing → Client billing, with Eligibility Check in an insurance client's row menu (once their insurance profile is complete).
From Billing → Bill sessions, in a session's three-dot menu → Check Eligibility.
From Billing → Eligibility checks.
When you start from a client's row or session, the Eligibility checks page opens straight into that client's check. You can also run checks on draft insurance for clients who haven't signed up yet.
What a check returns
Coverage status: active or inactive.
Network status: in-network, out-of-network, or unknown.
Mental health benefits: sessions allowed/used, copay, coinsurance, prior auth requirements.
Deductible info: individual and family, in-network and out-of-network, year-to-date and remaining.
Out-of-pocket info: maximums and remaining amounts.
Choosing the benefits Oasys uses
For a saved client, the result has a Cost sharing area with four sections: Copay, Coinsurance, Deductible and OOP.
Nothing is picked automatically. Tick one option per section (or leave it unselected if the amount is unknown) and click Save.
Oasys uses your saved choices to fill in the client's responsibility to be collected. Any manual billing override you've set still takes priority.
Use Edit to change them later.
Selections belong only to that check. Each later check starts with nothing selected.
Checking someone who isn't a client yet
Go to Billing → Eligibility checks, click New client check and choose New person. Those results are read-only and aren't saved to a client.
✅ Good to know: Eligibility checks may be charged per check. For details, contact your Oasys representative.
6. Secondary insurance
When a primary insurer partially pays and the client has secondary insurance, the claim's three-dot menu offers Bill Secondary Insurance and Acknowledge & bill patient.
Bill Secondary Insurance opens Review Secondary Claim. Check the details, then click Submit to Secondary Insurance. The secondary claim is created and sent together. If you close the review without submitting, nothing is saved.
The primary then shows a Billed to Secondary badge.
Jump between them with View Secondary Claim / View Primary Claim.
There's no tertiary-insurance step.
Frequently asked questions
Can I bill add-on codes or more than one unit?
Yes. Attach additional services (add-on CPT codes such as 90785 or 96131) and set units on the session. Each goes on the claim as its own line. See Additional services and units.
What's the difference between a claim, invoice, and superbill?
A claim is submitted to insurance for payment.
An invoice is sent to the client for direct payment.
A superbill is a statement the client submits to their insurance for reimbursement.
How long does it take to get paid on a claim?
After submission, acknowledgment usually takes 1–2 days and a payer decision 5–30 days. Timelines vary by payer.
What should I do with a denied claim?
Go to Manage claims → Needs attention and open the claim to review the denial reason. You can correct and resubmit, contact the payer to appeal, or write it off.
Why can't I void this claim?
Either the payer hasn't processed it yet, or the client's responsibility for it has been billed or marked as paid. Void or refund the responsibility invoice (or undo the external payment) first.