🖥️ For practice admins using Practice HQ on the web. You need the Billing permission, and these steps apply when your practice bills insurance through Oasys.
This article explains how to track and work insurance claims across your practice, customize how claims are built with claim rules, handle voids and outside payments, process remittances (ERAs), and verify client eligibility.
In this article
1. Tracking insurance claims
Manage claims is where you follow every insurance claim after it's created. Open Billing → Manage claims: "View, submit, and resolve insurance claims across your practice."
Tabs: All claims and Needs attention. To find draft claims, choose Draft in the status filter.
Filters: provider, payer, and status.
Summary tiles show billed, paid, and outstanding amounts, and follow your status filter. Voided claims aren't counted as outstanding.
What lands in Needs attention
Claims that were rejected, denied, failed to submit, or were processed with nothing paid.
Claims waiting on you for a payer takeback, a client-responsibility decision, an adjudication review, or a manual-payment conflict.
Claims where the payer assigned a client share that hasn't been billed yet.
A voided claim never needs attention.
The actions available on each claim depend on its status, so not every claim can be resubmitted or voided.
⚠️ Important: If your practice is on Fully-managed RCM, the Oasys billing team submits and works your claims. You can still follow their progress here. See Fully-managed RCM.
2. Claim statuses and badges
Every claim shows its claim status. Once the payer has processed it, the claim's client-responsibility status also shows, in its own column.
Status | What it means |
Draft | Saved but not yet submitted |
Submitting | Submission is being finalized (contact Oasys support if this persists) |
Submitted | Sent to the payer |
Received | The payer or clearinghouse received it but hasn't accepted it for processing yet |
Accepted | The payer accepted it for processing |
Rejected | The payer or clearinghouse rejected it before processing |
Denied | The payer processed and denied it |
Paid | Payment has been received |
Partially paid | The payer paid part and more payment is expected |
Patient responsibility | The payer assigned some or all of the allowed amount to the client |
Needs investigation | Processed with no payer payment and no client responsibility |
Submission failed | Couldn't be submitted; correct the problem and retry |
Voided | The claim was voided |
Client-responsibility statuses
Needs billing (the client's share hasn't been invoiced), Billed, Partially paid, Paid, and Closed.
Extra badges
Payment failed: the client's card payment for their share of the claim failed. Follow up from the claim's client-responsibility invoice.
Takeback pending: the payer is taking back a payment and the claim needs your review.
3. Working a claim
Open any claim to see its details and the actions available for its status.
The claim has Overview, Charges, History, and Payments tabs, plus Corrections when fields can be corrected.
The Providers card on Overview shows the Billing entity and the Rendering clinician, each with the NPI and Taxonomy that were sent on the claim.
A value shows Not sent when the claim went out without it (for example, when a claim rule omits the rendering provider), and Not available before the claim has been sent.
Claim actions
Submit Claim or Review & Submit: send a draft.
Resubmit Claim: send a corrected claim.
Bill Secondary Insurance: opens Review Secondary Claim. Click Submit to Secondary Insurance to create and send the secondary claim in one step. Closing the review saves nothing.
Acknowledge Responsibility: when the client has secondary insurance, their share isn't invoiced until you decide. Bill the secondary insurer, or acknowledge that the client owes it.
Check for Payment: look for a newly arrived remittance or payment update.
Mark Paid Manually / Undo Manual Payment: record a payer payment that didn't arrive as a remittance. To record a denial from a paper EOB, enter $0 in every amount and click Record denial; the claim is marked Denied and the undo button reads Undo Denial. Undo isn't available once a replacement claim has been created.
Manage PR Invoice: open the client-responsibility invoice.
Void Claim and Delete Claim (drafts only).
4. Voiding a claim
Voiding withdraws a claim from the payer. Use Void Claim on the claim's detail page.
You can void a claim only after the payer has processed it ("Claims cannot be voided until the payer has processed the claim").
A voided claim doesn't bill the client. Nothing is shown as owed on it, it isn't counted as outstanding, and it never needs attention.
A client-responsibility invoice can't be created on a voided claim, and its client share can't be recorded as paid outside Oasys.
⚠️ Important: You can't void a claim while its client responsibility is live. If the client's share has been invoiced (sent, paid, or failed), void or refund that invoice first. If it was recorded as externally paid, remove that record first. Clicking Void Claim tells you which applies.
5. Recording a payment made outside Oasys
Use this when a claim was processed elsewhere, for example a payer routed through a third-party administrator with no remittance returned.
Open the claim in Manage claims.
Click Mark Externally Paid for its client responsibility.
Enter how the payment was collected and click Record payment.
Use Undo External Payment if you recorded it in error. You can also undo it from Billing → External payments → Revert to unpaid.
If a real remittance later arrives for a claim you already marked externally paid, Oasys flags the conflict. Contact Oasys support to resolve it.
⚠️ Important: Mark a given claim externally paid only once. If the same client responsibility was already collected on a separate invoice, check with Oasys support first so the amount isn't counted twice for payroll. The client is never charged twice.
6. Claim rules
Claim rules customize the modifiers, NPIs, and other fields applied automatically when your practice's claims are built. Open Billing → Claim rules and click New rule.
Give the rule a name and, optionally, a description.
Click Add condition and choose what the claim must match (the When).
Click Add action and choose what to change (the Then).
Leave Rule is active on, then click Create rule.
All conditions must match before a rule runs. A rule with no conditions always applies.
Use the row menu to Edit or Delete a rule, and the On/Off switch to activate or deactivate it. Deleting doesn't affect claims already submitted.
Built-in rules marked Default can be edited or turned off, but not deleted.
Conditions you can match
Payer, Rendering provider, Provider type, Provider taxonomy, License type, and License state.
Room and Location (your practice's rooms and locations), Place of service, Service facility state, Session modality, and Session category.
Session category is Individual, Couple, Family or Group, based on the session itself: a group session is Group, a couple or family session is Couple or Family, and any other session is Individual.
CPT code, Tax ID type, Supervised, Supervisee role, EAP authorization, and Client state.
Use "is one of" to match several values at once.
Actions you can apply
Add modifier or Remove modifier. Choices include telehealth, phone, and supervision modifiers, plus behavioral health modifiers such as HQ (group setting), HR and HS (family or couple with or without the client present), SC, AJ, HJ, U7, and UD.
Set billing NPI, Set rendering NPI, Set rendering provider name, Set billing taxonomy, and Set rendering taxonomy.
Set place of service (including 53, Community Mental Health Center) and Set CPT code.
Set billing address: overrides the billing address on its own, without changing the billing provider.
Set service facility: a facility name, 10-digit facility NPI, and address for Boxes 32 and 32a, separate from the billing provider.
Omit rendering provider: leaves rendering provider details blank on the claim, including Box 24J. Billing provider details stay as they are.
Bill as individual: bills under the provider's own identity (see below).
Billing a payer under a provider's own NPI (Box 33)
Claims normally go out with your practice as the billing provider. If a payer needs a provider billed as an individual, add a rule with the condition Payer (and, for one provider, Rendering provider) and the action Bill as individual.
The claim then uses that provider's own name, NPI, tax ID, and taxonomy as the billing provider.
If the provider has no individual tax ID saved in their provider billing details, the rule is skipped and the claim bills under the practice as usual.
💡 Tip: Rules run in the order they were created. Modifiers from several rules add up (a claim line holds up to four). If two rules set the same field, the later-created rule wins, and editing a rule doesn't change its place. If a new rule would directly contradict an existing one, Oasys explains the conflict when you save.
7. Medicaid RIN on claims
Some Medicaid payers need the subscriber's Recipient Identification Number (RIN) on claims. When a client's payer uses a RIN, their insurance details show a Medicaid RIN field.
Enter the subscriber's nine-digit Medicaid RIN. Keep the card's Member ID for eligibility checks.
If the Member ID is also the RIN, tick Member ID is also the Medicaid RIN.
For payers that require it, the field is required before you can save.
You can add a RIN to primary and secondary insurance. The saved RIN is used on that coverage's claims and shows in the client's coverage summary.
Find it in the client's billing workspace → Settings → Insurance.
8. Processing remittances
A remittance (ERA, an 835 electronic file) is what an insurer sends when it pays or processes your claims. Open Billing → Payment remittances.
Remittances stay unavailable until your practice's NPI and Tax ID are saved ("Complete practice insurance setup (NPI & Tax ID) first"). See Your practice and provider insurance details.
Each remittance shows the check number, payer, date, and total amount.
It breaks down each claim: billed, allowed, paid, and client responsibility, with service dates and the provider.
It lists adjustments (contractual, write-off, deductible, copay, coinsurance) and any provider-level adjustments.
Each claim line is either matched to a claim in Oasys (click View claim to open it, then Back to return) or marked Unmatched. Unmatched lines stay on the remittance; Oasys doesn't match them for you.
Keeping the list tidy
Use the All Remittances and Archived tabs, and filter by search, status, and date.
Select remittances and click Archive, or Archive All for everything in the current filter. Restore them from Archived with Unarchive.
9. Verifying eligibility
Eligibility checks confirm a client's coverage and the benefits their payer reports. Open Billing → Eligibility checks. This appears only if insurance eligibility is turned on for your account.
Choose a client's insurance coverage row, or click New client check.
Click Run Check (or Re-check Coverage). The payer and provider stay locked to that coverage row.
Review the coverage status and benefits in the result.
The list shows insurance clients with their current coverage status, newest check first. Filter by provider, payer, status, or date.
New client check lets you choose a provider and an existing client with complete insurance; their saved payer stays attached. Or choose New person to enter insurance details for someone who isn't a client yet.
Results for a new person are read-only and aren't saved to a client.
Choosing the benefits Oasys uses
For a saved client, the result has a Cost sharing area with four sections: Copay, Coinsurance, Deductible, and OOP.
Review each section's options. Each shows the payer's heading and amount, with plan, network, setting, coverage level, and period. Expand Details to read payer notes.
Tick one applicable option per section, or leave a section unselected if the amount is unknown.
Click Save to use those benefits for the client's responsibility.
Nothing is selected automatically. A new check starts unselected.
Use Edit to change your choices and Save again. Cancel keeps the previous choices.
Sections can be collapsed separately; Save still saves choices in collapsed sections.
After saving, each section shows only the selected heading and amount, or Unknown if nothing was selected. An explicit $0 or 0% stays zero.
If someone else saved changes while you were editing, saving shows a conflict. Click Reload saved selections, then edit and save again.
Selections must belong to the same plan and can't mix in-network and out-of-network benefits.
Reading the result
Sections show mental-health options when the payer reports them, otherwise general plan options. Expand All mental-health benefits to review the rest of the payer's information.
Only benefits you can choose are listed. Deductible and OOP annual totals and spent amounts are hidden because they aren't remaining balances. Benefits for inactive or unconfirmed plans are hidden too.
Prior authorization shows as Required, Not required, or Unknown.
Active — authorization required means coverage is active but authorization needs attention. Follow-up Required means mental-health coverage needs confirmation. A failed check is labeled Check failed.
Benefits with no network specified are labeled. Selecting one doesn't confirm the provider's network status, and missing deductible information doesn't mean the deductible is waived.
If an extra mental-health request fails after a successful first check, the result keeps the first coverage information and warns that benefit amounts may be incomplete.
Results don't show "Patient pays" or "Insurance pays" estimates. Client responsibility is calculated in the client's billing workspace.
✅ Good to know: Saved selections from the latest check feed the client's billing. Manual billing overrides always take priority and are never changed by saving selections or running a new check. Editing an older check doesn't replace the latest check's inputs, and amounts already collected don't change.
Frequently asked questions
A claim was rejected or denied. What should I do?
Open the claim in Manage claims to see the reason. Correct what's needed and use Resubmit Claim, or contact Oasys support if you're not sure what to change.
Why can't I void this claim?
Either the payer hasn't processed it yet, or its client responsibility is live. Void or refund the client-responsibility invoice, or remove the external payment record, then try again.
Will the client be billed for a voided claim?
No. A voided claim has no client responsibility to bill.
How do I see which NPI and taxonomy went out on a claim?
Open the claim and look at the Providers card on Overview.
Can I add a modifier only for sessions in a particular room or location?
Yes. Create a claim rule with a Room or Location condition and an Add modifier action.
What does Unmatched on a remittance line mean?
Oasys couldn't link that line to a claim and doesn't match it for you. Contact Oasys support if you need help reconciling it.