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, six summary cards display counts for the current filter:
- Total Claims — the total number of claims matching your date range.
- Paid — claims with a paid status.
- Rejected — claims that were rejected by the payer.
- Reversed — claims that have been reversed.
- PharmPix — claims received from the PharmPix feed.
- S3 — claims received from an S3 EDI file upload.
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, 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, 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.