Test Rejected/Denied Claim

Testing claims in the sandbox is limited to the predefined data values but in production, you have the ability to submit test transactions through two methods:

  1. Send the value of '9496' as the tradingPartnerServiceId; this would allow for a claim submitted with live data to run through clearinghouse edits without being submitted to a payer.


  1. Add a value of usageIndicator:T to the claim; this would allow you to test against different tradingPartnerServiceIds and any payer-specific edits they may have.

These edits would be limited to clearinghouse level reporting as payer reports are not generated until claims are actually submitted. Additional information on claims FAQs can be found here.

Best Testing Approach to simulate and test scenarios with rejected/denied claims

Rejected claim information would come in the form of SF/SD reports through the Responses and Reports API. The denial or payment information would be returned specifically in the R5, which is the 835. The rejection information will be received automatically as payers process claims. Denial and payment information would only be sent to the clearinghouse once the ERA enrollment is completed.