This article explains how to open a claim in MedMe and read its details, payment breakdown, and remittances. It covers the summary shown on every tab and what each tab contains.
Table of Contents
Overview
The Claim Details modal is the read-only view of a claim. It shows what was submitted, the payer's response, and any payments received, without opening the claim for editing.
Opening the Claim Details Modal
Select a claim row in any of these places:
The Claims page.
The Claims card on the patient's Billing tab.
The Claims card on an appointment's tab.
Or open the row's ⋯ menu and select View Details. Close the modal with X or Esc.
Please Note: Draft claims do not have a Claim Details view because they have not been submitted. Selecting a draft opens it in the Edit Claim modal instead.
The Summary Band
The title shows Claim # followed by the claim identifier and the claim's status chip. Under it, on every tab:
Patient — select the name to open the patient's profile on the Billing tab.
Date of Service — the service date of the claim.
Linked Entity — the appointment the claim is for; select it to open the appointment.
Submitted On and Submitted By — when and by whom the claim was sent. Show a dash for Draft and Ready for Submission claims.
Total Billed — the sum of the service line charges.
Total Paid — the total paid by the payer; a dash until a remittance arrives.
Overview Tab
The Overview tab shows the payer section and the payment breakdown.
The payer's name with the payer-level status chip.
For a Rejected claim, the rejection reason returned by the clearinghouse or payer in plain language.
Payment Details — one row per service line with Line #, Procedure (the CPT / HCPCS code), Charge, Allowed, and Paid. Allowed and Paid show a dash until the claim is adjudicated.
See Remittances — appears once at least one remittance has been received and switches to the Remittances tab.
Details Tab
The Details tab shows the claim exactly as it was submitted:
Rendering Provider, Billing Provider, and Referring Provider — provider name, NPI, taxonomy, and TIN / EIN for the billing provider.
Payer — payer name, member ID, subscriber, relationship, and date of birth as they were on the insurance at submission time.
Claim — place of service and the full list of diagnosis codes.
Service 1, Service 2 … — for each line: Ref ID, CPT code, ICD codes, modifiers, units, billed, and paid amounts.
Please Note: The Details tab is a snapshot. If the patient's insurance or a provider is edited after the claim was submitted, the claim still shows the values that were sent to the payer.
Remittances Tab
The Remittances tab lists the electronic remittance advice (ERA / 835) received from the payer.
A summary row with the total received.
One section per remittance with the payer, date received, and amount.
Line items for each remittance with the procedure, charge, allowed, and paid amounts.
Until the payer responds, the tab shows This claim doesn't have any remittances yet. Draft, Ready for Submission, Submitted, and Accepted claims will always show this message.
Tip: For a Partially Paid or Denied claim, compare the line items here with the Payment Details on the Overview tab to see which lines were not paid before editing and resubmitting.
Activity Tab
The Activity tab will show a timeline of clearinghouse and payer events for the claim. It is not available yet.
Troubleshooting
Total Paid and the Paid column show a dash. No remittance has been received. Check back after the payer adjudicates the claim.
The payer paid, but no remittance appears. Remittances only arrive electronically when the pharmacy's ERA enrolment with that payer is complete. Contact the MedMe RCM team.
The Details tab shows a provider marked (deleted). The provider was removed from the pharmacy's provider list after this claim was created. The claim still holds the submitted name and NPI.
I need to change something I see on the Details tab. Close the modal and use Edit from the claim's ⋯ menu. Editing is only available for Rejected, Denied, and Partially Paid claims (and drafts, which open in Edit Claim directly).
Conclusion
The Claim Details modal gives a complete read-only picture of a claim: the summary band for status and totals, Overview for the payer response and per-line payments, Details for exactly what was submitted, and Remittances for the payer's payments and adjustments.
See more:
If additional assistance is needed, contact the MedMe RCM team.