Have you submitted claims through Tebra but still cannot determine why some remain unpaid? A claim may be awaiting payer processing, rejected by a clearinghouse, denied by an insurer, or delayed because information needs correction. Without a reliable tracking process, these claims can remain unresolved while your billing team focuses on new submissions.
To track unpaid claims in Tebra, you need to identify each claim’s current status, review its processing history, and determine the next action. Tebra provides claim-status tools and reporting features that help practices investigate these issues.
This guide explains how to check claim status in Tebra Practice Management, investigate common problems, and build a consistent follow-up workflow that helps your practice keep claims moving toward payment.
How to Track Unpaid Claims in Tebra Practice Management
Tebra’s desktop Practice Management application includes a Track Claim Status workflow for finding claims and reviewing their status. The exact options available depend on the claim, your user permissions, and the product version.
Step 1: Open Track Claim Status
In Tebra’s documented desktop workflow:
- Open Encounters > Track Claim Status.
- Use the available search filters to narrow the claim list.
- Select the appropriate claim status or leave the status filter on its default setting to search across statuses.
- Click Find Now to display matching claims.
- Open the relevant claim to review its details.
You can use the filters to locate specific claims rather than searching through every outstanding account. If you need more detail, open the claim record and review its transaction history.
Step 2: Review the Claim’s Current Status
Finding a claim is only the first part of the process. You also need to understand what its status means and whether further action is required.
Review the available claim information, submission history, and related processing reports. Determine whether the claim is ready for submission, has been sent, was rejected, or has progressed to another stage.
Step 3: Check the Claim Transaction History
Open the claim and review its transaction history to understand what has happened since submission. Look for available records of claim actions, status changes, and related processing activity.
If the claim appears unpaid but its history shows no clear payer response, investigate further before deciding whether to correct, resubmit, or escalate it. Repeatedly submitting the same claim without identifying the underlying issue can create additional work and potential duplicate-claim problems.
How to Interpret Unpaid Claim Statuses in Tebra
The next action depends on what you discover. Use the following table as a practical guide rather than assuming that every Tebra workflow uses identical status labels.
| Claim Situation | What It May Indicate | Recommended Next Step |
|---|---|---|
| Ready to Submit | The claim has not yet been sent to the clearinghouse or payer. | Verify the claim information and submit it when appropriate. |
| Clearinghouse Rejection | The claim failed a validation check before reaching the payer. | Review the rejection message, correct the issue, and resubmit the claim. |
| Payer Rejection | The payer or its processing partner rejected the submitted claim. | Review the payer’s message and correct the identified problem. |
| Waiting for Adjudication | The claim is awaiting a payer decision. | Confirm receipt and follow up if processing is delayed. |
| Denied | The payer processed the claim but did not approve payment as submitted. | Review the explanation of benefits or remittance advice and determine whether correction or appeal is appropriate. |
| Paid, with a Remaining Balance | Payment may have been partial, or another balance may remain. | Reconcile the payment, adjustments, and any valid remaining responsibility. |
| Status Unclear or No Recent Activity | The available records do not establish what happened next. | Review transaction history and processing reports, then verify the claim with the payer if necessary. |
A claim’s status should guide your investigation, not replace it. For example, a rejected claim usually needs correction, while a claim awaiting adjudication may need status verification and follow-up. A denial requires a review of the payer’s stated reason and the applicable correction or appeal process.
Use Tebra Claim Processing Reports to Investigate Problems
If an unpaid claim’s status does not explain the delay, review its related claim processing reports. These reports can help identify problems that occurred after electronic submission.
Tebra documents three main types of claim processing reports:
- Internal validation reports: Identify missing or invalid information detected by Tebra before claims are forwarded to the clearinghouse.
- Clearinghouse acknowledgement and rejection reports: Show whether the clearinghouse acknowledged or rejected submitted claims.
- Payer acknowledgement and rejection reports: Help identify whether the payer acknowledged or rejected the claim during its initial validation process.
To access these reports in the documented desktop workflow:
- Navigate to Encounters > Clearinghouse Reports.
- Select the Claim Processing tab.
- Locate the report associated with the claim.
- Open the report and review its status and message details.
- Record the issue and determine the appropriate corrective action.
Tebra’s official Claim Processing Reports guide explains how to locate and review these reports.
Tebra recommends monitoring clearinghouse reports regularly and taking action on identified rejections. A daily review can help billing teams catch submission problems before they remain unresolved for an extended period.
How to Follow Up on Unpaid Claims
Once you know why a claim remains unpaid, assign a specific action and a follow-up date. A claim should not remain on a worklist simply because someone reviewed it.
Investigate Rejected Claims
Read the rejection message carefully and identify the information that needs correction. Depending on the issue, you may need to review patient demographics, insurance details, payer identification, provider information, coding, or other claim data.
Correct the underlying problem before resubmitting the claim. If the message is unclear, consult the relevant Tebra troubleshooting documentation or contact the clearinghouse or payer for clarification.
Follow Up on Claims Awaiting Payer Processing
If the claim was accepted for processing but remains unpaid, verify that the payer received it and determine its current status. Ask whether additional documentation is required, whether the claim is still being processed, or whether another issue is preventing adjudication.
Document the contact date, reference number when available, information received, and next follow-up date. These records help another team member continue the process without repeating the same investigation.
Review Denied Claims
A denial requires a different approach from a submission rejection. Review the payer’s explanation of benefits or electronic remittance advice to identify the reason for nonpayment.
Then determine whether the claim should be corrected, appealed, supported with additional documentation, or handled through another payer-specific process. Confirm applicable deadlines before deciding on the next step.
Resubmit Corrected Claims When Appropriate
Before rebilling, verify that the correction addresses the actual problem. Follow the payer’s instructions for corrected claims and check the claim history to avoid unnecessary duplicate submissions.
Tebra provides a Rebill Claims guide for its documented desktop workflow. Available actions may vary depending on the claim’s status and the user’s permissions.
Build a Consistent Insurance Claim Tracking Workflow
Effective insurance claim tracking for medical practices depends on more than checking claim statuses occasionally. Teams need a repeatable process that identifies unresolved claims, assigns ownership, and confirms whether each action produces a result.
A practical workflow should include these steps:
1. Review new submissions. Check claim processing reports for internal validation issues and clearinghouse or payer rejections.
2. Create a follow-up worklist. Group unresolved claims by status, age, balance, payer, and urgency. Include the reason for follow-up and the next action.
3. Prioritize time-sensitive claims. Investigate claims approaching applicable filing or appeal deadlines before they become harder to recover. Follow the specific payer’s rules and contract requirements.
4. Assign responsibility. Make sure each claim has an owner responsible for the next step. Record a follow-up date so unresolved claims do not disappear between billing tasks.
5. Verify the outcome. After correcting, resubmitting, or contacting a payer, check the claim again. Confirm whether the status changed, additional action is needed, or payment was posted.
6. Review recurring issues. Group rejections and denials by cause to identify patterns. If the same problem repeatedly affects claims, improve the underlying billing process instead of correcting each claim in isolation.
This workflow can be maintained through Tebra’s available claim-status and reporting features, supplemented by an internal worklist where necessary.
Which Metrics Help Track Unpaid Claims?
Monitoring a few practical measures can help billing teams identify backlogs and determine whether follow-up efforts are effective.
| Metric | What It Helps You Understand |
|---|---|
| Number of Unresolved Claims | How many claims still require action. |
| Unpaid Balance by Claim Age | Where older or higher-value balances are accumulating. |
| Rejection Volume and Reasons | Which submission issues need correction. |
| Denial Volume and Reasons | Which payer decisions require investigation or appeal. |
| Claims Awaiting Payer Response | Which accounts may need status verification. |
| Follow-Up Completion | Whether assigned actions are being completed on schedule. |
| Payments Received After Follow-Up | Whether claim resolution efforts are moving balances toward payment. |
Use consistent reporting periods and definitions when comparing results. A reduction in the number of unresolved claims is useful, but it should be considered alongside total outstanding balances, payment posting, adjustments, and the reasons claims remain open.
How to Manage Kareo Claim Status and Tebra Claims Management
Some practices still use the name Kareo when referring to their billing workflows. The relevant approach remains the same: locate the claim, review its status and history, investigate processing messages, and determine the next action.
For practices using Tebra or Kareo Practice Management, consistent Tebra claims management can help reduce overlooked follow-ups and improve visibility into unresolved accounts. However, the available interface and workflow may differ depending on the product version and configuration.
If your billing team needs help with claim tracking, denial follow-up, or aged balances, RCM Experts provides Kareo and Tebra medical billing support. Its services include claim submission support, rejection handling, denial management, and A/R follow-up.
When Should a Practice Consider Additional Claims Support?
Internal teams may struggle to keep up with unpaid claims when submission volume rises, staff capacity is limited, or repeated rejections and denials create additional work.
Consider reviewing your workflow if claims repeatedly go without follow-up, older balances continue to accumulate, or staff cannot consistently document the next action for unresolved accounts.
RCM Experts also offers medical claims A/R recovery services for practices that need support investigating aged claims and pursuing appropriate resolutions.
Before engaging an external team, establish who will handle each task, how claim activity will be documented, which performance measures will be reviewed, and how access to billing information will be controlled.
Final Takeaway
To track unpaid claims in Tebra, start by locating each claim through Track Claim Status, reviewing its transaction history, and checking the relevant processing reports. Use the information to distinguish between claims awaiting payer processing, rejected submissions, denials, and balances that need further investigation.
A consistent follow-up process should assign responsibility, document each action, monitor deadlines, and verify whether the claim ultimately moves toward resolution. Regular reporting and analysis of recurring issues can also help practices prevent avoidable delays.
If your team needs additional help with Tebra claim tracking, denial follow-up, or unpaid balances, explore RCM Experts’ Tebra billing services.
Frequently Asked Questions
How do I check claim status in Tebra?
In Tebra’s documented desktop workflow, navigate to Encounters > Track Claim Status, apply the available filters, and click Find Now. Open the relevant claim to review its details and transaction history.
How can I find unpaid claims in Tebra Practice Management?
Use Track Claim Status to locate claims and narrow the results with the available status filters. Review the claim details and related processing reports to determine which accounts remain unresolved and require follow-up.
Why is a Tebra claim still unpaid after submission?
A claim may be awaiting payer adjudication, rejected by a clearinghouse or payer, denied, or delayed because additional information is required. Review the claim history and processing reports to identify the actual cause before taking action.
Where can I find rejected claims in Tebra?
In the documented desktop workflow, navigate to Encounters > Clearinghouse Reports and open the Claim Processing tab. Review the relevant internal validation, clearinghouse, or payer report for rejection details.
What is the difference between a rejected and a denied claim?
A rejection generally means a claim failed a validation check during submission or initial processing. A denial means the payer has made a nonpayment decision. The appropriate response depends on the rejection message or denial reason.
How often should medical practices review unpaid claims?
Practices should review claim processing reports regularly and act promptly on rejections, deadline-sensitive claims, and unresolved payer issues. The frequency of broader unpaid-claim reviews should reflect claim volume, staffing, and payer requirements.
Can I track Kareo claim status using Tebra workflows?
Tebra’s documented Practice Management workflow includes Track Claim Status and related claim processing reports. The exact steps available to a practice depend on its product version, configuration, and user permissions.
