This article explains what to do when a claim in MedMe comes back Rejected, Denied, or Partially Paid: how to find the reason, correct the claim or the patient's insurance, and resubmit it.
Please Note: This article helps you assess and resolve rejected or denied claims on your own. The MedMe RCM team also monitors your claims and is always available to help. Contact them any time you need support.
Table of Contents
Overview
Most rejections and denials trace back to a small set of causes: a payer or member ID that does not match, a missing modifier, a code the payer does not cover, or a duplicate. In MedMe the correction is made on the same claim and resubmitted, so the history stays together under one claim number.
Rejected vs Denied vs Partially Paid
Rejected — the clearinghouse or payer refused the claim before adjudicating it, usually because information was missing or did not match. Nothing was paid. Fix and resubmit.
Denied — the payer adjudicated the claim and declined to pay. Reason codes are in the remittance. Fix and resubmit, or bill through another benefit.
Partially Paid — the payer paid some lines or amounts and adjusted or denied the rest. Review the remittance; resubmit only if a correction would change the outcome.
Step 1: Find the Reason
Open the claim from the Claims page, the patient's Billing tab, or the appointment's Claims card.
On the Overview tab, read the rejection reason shown under the payer's name for a Rejected claim.
For Denied and Partially Paid claims, open the Remittances tab and compare the paid and allowed amounts per line with the charges.
Step 2: Correct the Claim or the Insurance
If the problem is in the claim (wrong code, missing modifier, wrong units, wrong provider):
Open the claim's ⋯ menu and select Edit. The Edit Claim modal opens with everything that was submitted.
Correct the field. The bookmarks on the left jump to each service line.
If the insurance details are wrong (wrong member ID, name spelling, or date of birth):
Go to the patient's profile and correct the insurance in the Insurance card. See How to Add and Manage a Patient's Insurance in MedMe.
Return to the claim, select Edit, and resubmit it.
If the claim was billed to the wrong insurance (wrong payer, or the patient has a different plan):
A claim's payer cannot be changed after the claim is saved.
Add the correct insurance on the patient's profile if it is not there yet.
Create a new claim for the same appointment and select the correct insurance in the Payer field. See How to Create and Submit a Claim in MedMe.
Tip: Run Verify on the corrected insurance before resubmitting. An Active eligibility response confirms the payer now recognizes the patient.
Step 3: Resubmit
In the Edit Claim modal, select Resubmit.
The claim returns to Ready for Submission and the message Claim … has been queued for resubmission. Undo within 24 hours appears with an Undo action.
Overnight the corrected claim is sent and the status becomes Resubmitted. The payer's next response updates the same claim.
Reminder: Undo Submission on a resubmission returns the claim to its previous status (Rejected, Denied, or Partially Paid), not to Draft. Earlier remittances stay on the Remittances tab after a resubmission.
Troubleshooting
Edit is not in the menu. Only Draft, Rejected, Denied, and Partially Paid claims can be edited. A Submitted claim must wait for the payer's response; an Accepted claim can be cancelled.
The rejection reason is unclear. Contact the MedMe RCM team with the claim number; the team reviews the clearinghouse response and advises on the fix.
The rejection mentions enrolment or says the provider is not recognized. The pharmacy's EDI enrolment with that payer may not be complete. Contact the MedMe RCM team before resubmitting.
The Payer field is greyed out in Edit Claim. A claim's insurance cannot be changed. Create a new claim against the correct insurance.
The correct insurance does not appear in the Payer list on a new claim. Only the patient's Active insurances are offered. Set the insurance to Active on the profile.
Timely filing. Payers limit how long after the date of service a claim can be filed (Medicare allows 12 months). Act on rejections promptly.
Conclusion
When a claim is rejected or denied: open it to read the reason, fix the claim with Edit or fix the insurance on the patient profile, then select Resubmit. If the claim went to the wrong insurance, create a new claim against the correct one. The correction goes out overnight on the same claim number, and the payer's response updates the claim in place.
See more:
If additional assistance is needed, contact the MedMe RCM team.