Understanding Claim Statuses
Each line item in a claim has a status. Because claims can have multiple line items, they can also have multiple statuses. The statuses of a claim are a collection of all the statuses of its line items.
The status of a claim determines how it can be edited and processed. For example, you cannot bill a claim to a carrier until you set the status of the claim to Ready to Bill.
The following table describes all the claim statuses in AcuityLogic and the actions you can perform on a claim while the claim (or line item) has the specified status.
| Status | Description | Search Claims Actions | Claim Detail | ||
|---|---|---|---|---|---|
| Actions | Buttons | Line Item Actions | |||
|
Claim is ready to be billed to the insurance carrier. |
- Claim History - Preview CMS - Print CMS Form - Edit Claim - On Hold |
- Print Lab Order - Print Receipt - Add Note - View Notes - View Documents |
- View Claim - Edit Claim - Ready to Bill Patient - Bill to Carrier - On Hold - Generate CMS Form |
- Cancel - Ready to Bill Patient - Adjustment |
|
|
Claim was placed on hold, either manually or by AcuityLogic. This indicates that the claim needs review and changes. |
- Claim History - Edit Claim |
- Print Lab Order - Print Receipt - Add Note - View Notes - View Documents |
- View Claim - Edit Claim - Ready to Bill Patient - Ready to Bill Carrier |
- Cancel - Ready to Bill Patient - Ready to Bill Carrier |
|
|
Claim was billed to the insurance carrier through web billing or printed on a CMS 1500 form. |
- Claim History - Preview CMS - Print CMS Form - Reprint CMS Form - Patient Billing - Edit Claim - On Hold - Write Off |
- Print Lab Order - Print Receipt - Add Note - View Notes - View Document - Copy Claim |
- View Claim - Edit Claim - Ready to Bill Patient - Write Off - On Hold - Generate CMS Form |
- Cancel - Ready to Bill Patient - Adjustment - Write Off |
|
|
Claim was billed and paid in full. |
- Claim History - Edit Claim - Write Off |
- Print Lab Order - Print Receipt - Add Note - View Notes - View Documents - Copy Claim |
- View Claim - Edit Claim - Write Off |
- Adjustment - Write Off |
|
|
Claim has had no activity for 60 days. |
- Claim History - Preview CMS - Edit Claim - Write Off |
- Print Lab Order - Print Receipt - Add Note - View Notes - View Documents - Copy Claim |
- View Claim - Edit Claim - Ready to Bill Patient - Ready to Bill Carrier - Write Off |
- Ready to Bill Patient - Ready to Bill Carrier - Write Off |
|
|
Claim was underpaid and needs action. |
- Claim History - Preview CMS - Patient Billing - Edit Claim - Write Off |
- Print Lab Order - Print Receipt - Add Note - View Notes - View Documents - Copy Claim |
- View Claim - Edit Claim - Ready to Bill Patient - Ready to Bill Carrier - Write Off |
- Cancel - Ready to Bill Patient - Ready to Bill Carrier - Write Off |
|
|
Claim was overpaid and needs action. |
- Claim History - Edit Claim - Write Off |
- Print Lab Order - Print Receipt - Add Note - View Notes - View Documents - Copy Claim |
- View Claim - Edit Claim - Ready to Bill Patient - Ready to Bill Carrier - Write Off - Adjustment |
- Cancel - Ready to Bill Patient - Ready to Bill Carrier - Adjustment - Write Off |
|
|
Claim was rejected by the insurance carrier (for example, for invalid provider information). |
- Claim History - Preview CMS - Edit Claim - Write Off |
- Print Lab Order - Print Receipt - Add Note - View Notes - View Documents - Copy Claim |
- View Claim - Edit Claim - Ready to Bill Patient - Ready to Bill Carrier - Write Off |
- Cancel - Ready to Bill Patient - Ready to Bill Carrier - Write Off |
|
|
Claim was canceled and may require action. |
- Claim History - Preview CMS |
- Print Lab Order - Print Receipt - Add Note - View Notes - View Documents - Copy Claim |
- View Claim |
- None |
|
|
Claim is ready to bill to the patient. If the carrier rejects a claim and gives a reason similar to “patient not eligible for benefits,” you can change the status to Ready to Bill Patient. |
- Claim History - Preview CMS - Generate Patient Letter - Edit Claim - On Hold - Write Off |
- Print Lab Order - Print Receipt - Add Note - View Notes - View Documents |
- View Claim - Edit Claim - Ready to Bill Carrier - Write Off - On Hold - Generate Patient Letter |
- Cancel - Ready to Bill Carrier - Adjustment - Write Off |
|
|
Claim was billed to patient and is awaiting action. |
- Claim History - Preview CMS - Generate Patient Letter - Edit Claim - On Hold - Write Off |
- Print Lab Order - Print Receipt - Add Note - View Notes - View Documents - Copy Claim |
- View Claim - Edit Claim - Ready to Bill Carrier - Send to Collections - Write Off - On Hold - Generate Patient Letter |
- Cancel - Ready to Bill Carrier - Adjustment - Write Off |
|
|
All or part of the receivable for the claim was written off. |
- Claim History - Preview CMS - Print CMS Form - Edit Claim - Write Off |
- Print Lab Order - Print Receipt - Add Note - View Notes - View Documents - Copy Claim |
- View Claim - Edit Claim - Ready to Bill Patient - Ready to Bill Carrier - Write Off - Generate CMS Form |
- Ready to Bill Patient - Ready to Bill Carrier - Write Off |
|
|
Claim was sent to collections. |
- Claim History - Preview CMS |
- Print Lab Order - Print Receipt - Add Note - View Notes - View Documents - Copy Claim |
- View Claim |
- None |
|
|
Carrier will not be reimbursed for at least one item on the claim. |
- Claim History - Preview CMS - Edit Claim |
- Print Lab Order - Print Receipt - Add Note - View Notes - View Documents - Copy Claim |
- View Claim - Edit Claim |
- Cancel |
|