> ## Documentation Index
> Fetch the complete documentation index at: https://docs.sigmahmis.com/llms.txt
> Use this file to discover all available pages before exploring further.
# Prepare, Validate, and Submit an Insurance Claim in Sigma
> Prepare, validate, and submit an insurance claim from a confirmed invoice in Sigma Health HMIS. Catch errors before they reach the insurer.
A rejected claim delays payment you've already earned. Sigma's claim preparation flow checks for the most common submission errors before the claim leaves the clinic — so you spend less time chasing rejections and more time collecting what you're owed.
Navigate to the **Billing** module and locate the confirmed invoice you want to claim against. You can search by patient name, invoice number, or date of service.
Verify that the invoice status shows **Confirmed** before proceeding. Only confirmed invoices are eligible for claim creation. If the invoice is still in draft, complete and confirm it first.
From the confirmed invoice, click **Create Claim**. Sigma pre-fills the claim form with:
* Patient demographics and scheme membership details
* Visit date, encounter type, and treating provider
* All billing line items from the invoice, including procedure and diagnosis codes
Review the pre-filled data before continuing. If any field looks incorrect, return to the invoice or patient record to correct it at the source.
Some fields require manual entry because they are specific to each claim. Fill in:
* **Authorisation number** — Required by most schemes for procedures, specialist visits, and inpatient care. Obtain this from the scheme before or at the time of service.
* **Claim type** — Select the appropriate type: primary, secondary, or supplemental.
* **Treating provider details** — Confirm the provider's practice number or registration number as required by the scheme.
* **Additional diagnostic codes** — Add any secondary ICD codes that support the primary diagnosis.
If the scheme does not require an authorisation number for this claim type, leave the field blank — do not enter a placeholder value.
Click **Validate Claim** before submitting. Sigma checks the claim against the scheme's rules and flags any of the following issues:
* Missing or invalid authorisation number
* Unrecognised or inactive scheme codes
* Diagnosis and procedure code mismatches (e.g., gender-specific procedure on a mismatched patient record)
* Incomplete treating provider details
* Line items that exceed scheme benefit limits
Each error includes a description and the field to correct. Fix every flagged error, then run validation again to confirm the claim is clean.
Once validation passes with no errors, click **Review Claim** to see the finalised claim in full. Confirm that:
* All line items and amounts match the invoice
* The scheme and membership details are correct
* The authorisation number is present if required
Click **Submit**. Sigma records the submission timestamp and stores a read-only copy of the submitted claim for your records.
After submission, Sigma displays the **claim reference number** returned by the system. Record this number — you will need it to track the claim status and to reference the claim in any follow-up with the insurer.
The claim now appears in your Claims queue with the status **Submitted**.
## After Submission
The submitted claim is visible in your **Claims** module queue. Sigma tracks the submission date automatically. From the queue you can monitor status changes as the insurer processes the claim — from Submitted through to Awaiting Response, Approved, Rejected, or Paid. No manual status updates are needed if your scheme supports electronic remittance.
## Handling Rejections
When a claim is rejected, open the claim record from the Claims queue. The rejection reason code and description are displayed in the **Status** section.
To correct and resubmit:
1. Review the rejection reason and identify the field or data causing the problem.
2. Click **Edit Claim** to unlock the record for correction.
3. Fix the issue — for example, update the authorisation number, correct a diagnosis code, or amend provider details.
4. Run validation again to confirm the correction resolves the error.
5. Click **Resubmit**.
Always resubmit from the existing claim record. Creating a new claim for the same invoice creates a duplicate submission and may trigger a double-billing flag with the insurer.
Some rejections cannot be resolved by correcting claim data — for example, when an insurer denies a service they classify as non-covered or experimental. In these cases, you may need to appeal directly with the scheme.
To prepare for an appeal:
1. Note the rejection code from the claim record in Sigma.
2. Open the submitted claim and export or print the claim summary — this gives you the original submission data to reference.
3. Contact the scheme's provider relations or dispute resolution team with the claim reference number, submission date, and the exported claim details.
Sigma retains a complete audit trail of every submission and status change on the claim record, which you can reference throughout the appeal process.
Always resolve validation errors before submitting. Submitting a claim with known errors uses your filing window with the insurer — most schemes enforce a deadline for initial submissions, and a rejected claim that misses the resubmission window may not be recoverable.
## Related
Manage your full claims queue, track statuses, and configure scheme rules.
Match insurer remittances to approved claims and close the revenue trail.
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