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Checking Claim Status in VerifyTreatment

Claims lets you check the status of claims you've already submitted to a payer, without logging into payer portals or calling the payer. VerifyTx sends a claim status request and shows you the payer's response, including billed and paid amounts, check details, and status messages. Claims checks status only. It does not submit claims, post payments, or guarantee that a payer will pay a claim.

 Before you begin

Claims must be turned on for your account, and your account needs available claims credits. If you don't see Claims in the left navigation, contact your account manager or Support.

Claims credits are separate from your VOB and Insurance Discovery credits.

What you need

  • The facility (provider) that billed the claim
  • The insurance company
  • The patient's first name, last name, date of birth, and gender
  • The patient's member ID
  • The claim start date and end date for the claims you want to look up

Check a claim

  1. Click Claims in the left navigation.
  1. Click New Claim.
  1. Select the Provider / Facility and Insurance Company.
  1. Enter the patient's name, date of birth, gender, and member ID.
  1. Enter the Claim Start Date and Claim End Date.
  1. Submit the request.

If a claim is found for the dates you entered, the Claim Details page opens.

The 30-day date range

The range between the start and end date can be no longer than 30 days. If you need to look at a longer period, submit more than one request.

How credits are used
  • Each request uses one claims credit, even if the payer returns several claims.
  • Re-check Claim sends a new request and uses a new credit.

The Claims list

The Claims page lists your requests. You can search the list, and each row shows:

  • Name
  • Facility
  • Insurance company
  • Total billed
  • Total collected
  • Percent collected
  • Claim start and end dates
  • Updated at

Click a row to open its details.

If a request doesn't return what you expect

Not every payer supports claim status checks from outside systems, and payers sometimes can't return a status based on the information submitted. You may see a message from the payer such as one saying it cannot provide status electronically, or that information is missing or invalid.

Try these steps:

  1. Confirm the member ID, name, date of birth, and gender match the insurance card.
  1. Check that the facility and insurance company are correct.
  1. Make sure the date range covers the dates of service for the claim.
  1. Open the claim and use Edit to correct anything, then Re-check Claim. This uses a new credit.

If the same message keeps appearing, contact Support with the patient's name, the payer, and the date range you used.

Using the API

Claims can also be requested through the V2 API. Reach out to Support to confirm which environment fits your needs.