Monitoring EDI Claims

The EDI Claims viewer shows all pharmacy claims your organization has received through EDI feeds. This area requires EDI access and is available to users with the appropriate ability enabled.

Accessing EDI Claims

From the left navigation, select EDI Claims.

Setting the submission date range

At the top of the page, a Submission date range section lets you filter by a From and To date. Both date fields are optional — leave them empty to view all claims regardless of submission date. Changing either date immediately refreshes the stat cards and claims table below.

KPI stat cards

Just below the date range, summary cards display counts for the current filter. Each card has an information icon — hover it for a short description.

• Total Claims — every claim received in the selected submission date range.
• Paid — fills the plan paid for and that were not later voided.
• Rejected — claims the plan turned down. The rejection code explains why.
• Reversed — original fills that were later voided.
• Reversal — the transaction that voids a prior fill.
• PharmPix — claims that came in from the PharmPix feed.
• S3 — claims that came in from an uploaded EDI file.

A reversed fill and its reversal always come in pairs, so a fill that was voided and then re-filled shows the original fill, its reversal, and the new paid fill. Only the new paid fill counts as a live fill.

These cards follow the submission date range only. Searching or filtering the table below does not change them.

Searching and filtering the claims table

Below the stat cards, a filter bar lets you narrow the table:

• Search — type any text to search across claim fields.
• Status — filter by Paid, Rejected, Reversed, Reversal, or Unknown.
• Source — filter by PharmPix or S3.
• Reject code — enter a specific rejection code (for example, 75) to find claims with that code.

All filters work together. To clear a filter, select the × on its field.

Use the page-size selector and the ‹ / › buttons at the bottom of the table to move through results.

Select Refresh in the page header to reload both the stats and the table with the latest data.

The claims table

Each row in the table represents one pharmacy claim and shows:

Column	What it shows
Submission Date	The date the claim was submitted
Fill Date	The date the prescription was filled
Patient	The patient name (links to the patient record)
Ingredients	Active ingredient(s) in the claim
Brand	Brand name of the medication
NDC	National Drug Code
Source	PharmPix or S3, color-coded
Status	Paid, Rejected, Reversed, Reversal, or Unknown, color-coded
Rejection Codes	Up to three rejection codes (truncated if more)
Guideline	Whether a guideline is associated with this drug

Click any row to navigate to the patient record for that claim.

Opening the claim diagnostic panel

Each row has a bug icon on the right side. Select it to open the Claim diagnostic panel, which shows the full details of that claim, including the matched patient, claim data, guideline status, and any linked task or PA record. This is useful for investigating why a claim was rejected or for confirming a claim is correctly associated with a patient.

Close the panel by selecting × or clicking outside it.