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Claim Statuses

Each line item on a claim has a status, which communicates the processing stage for the line item. Since each claim can have multiple line items, a claim can also have multiple statuses. A claim’s statuses are a collection of all the statuses of its line items.

A claim’s status determines how the claim can be edited and processed. For example, you cannot bill a claim to a carrier until the claim’s status is set to Ready to Bill.

The following table describes all of the claim statuses in Claims Management, as well as the actions you can perform on the claim while the claim (or line item) has a specific status:

Status

Description

Actions (Process Claim)

Actions (Claim Detail)

Buttons (Claim Detail)

Line Item Actions

Ready to Bill

Claim is ready to be billed to the insurance carrier.

Claim History

Preview CMS Form

Print CMS Form

Edit Claim

On Hold

Print Lab Order

Print Receipt

Add Note

View Notes

View Claim

Edit Claim

On Hold

Generate CMS Form

Preview CMS Form

Adjustment

On Hold

Claim has been placed on hold, manually or by the Claims Management system. Indicates that the claim needs review and changes. Claims are automatically placed on hold when you select Edit Claim.

Claim History

Preview CMS Form

Edit Claim

Print Lab Order

Print Receipt

Add Note

View Notes

Edit Claim

Bill to Patient

Ready to Bill

Void

Ready to Bill Patient

Ready to Bill Carrier

Billed

Claim has been billed to the insurance carrier, through web billing or printed on a CMS 1500 form.

Claim History

Preview CMS Form

Print CMS Form

Reprint CMS Form

Patient Billing

Edit Claim

On Hold

Write Off

Print Lab Order

Print Receipt

Add Note

View Notes

Copy Claim

View Claim

Edit Claim

Write Off

On Hold

Generate CMS Form

Preview CMS Form

Adjustment

Write Off

Fully Paid

Claim has been billed and paid in full.

Claim History

Edit Claim

On Hold

Write Off

Print Lab Order

Print Receipt

Add Note

View Notes

Copy Claim

View Claim

Edit Claim

Write Off

On Hold

Adjustment

Write Off

Billed - No Activity for 60 Days

Claim has had no activity for 60 days.

Claim History

Preview CMS Form

Edit Claim

On Hold

Write Off

Print Lab Order

Print Receipt

Add Note

View Notes

Copy Claim

View Claim

Edit Claim

Ready to Bill

Write Off

On Hold

Preview CMS Form

Ready to Bill Carrier

Adjustment

Write Off

Underpaid

Claim has been underpaid and needs action.

Claim History

Preview CMS Form

Patient Billing

Edit Claim

On Hold

Write Off

Print Lab Order

Print Receipt

Add Note

View Notes

Copy Claim

View Claim

Edit Claim

Write Off

On Hold

Write Off

Overpaid

Claim has been overpaid and needs action.

Claim History

Edit Claim

On Hold

Write Off

Print Lab Order

Print Receipt

Add Note

View Notes

Copy Claim

View Claim

Edit Claim

Write Off

On Hold

Adjustment

Adjustment

Write Off

Rejected

Claim was rejected by the insurance carrier (for example, for invalid provider information).

Claim History

Preview CMS Form

Edit Claim

On Hold

Write Off

Print Lab Order

Print Receipt

Add Note

View Notes

Copy Claim

View Claim

Edit Claim

Write Off

On Hold

Write Off

Void

Claim has been canceled and may require action.

Claim History

Preview CMS Form

Print Lab Order

Print Receipt

Add Note

View Notes

Copy Claim

View Claim

None

Ready to Bill Patient

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 Form

Generate Patient Letter

Edit Claim

On Hold

Write Off

Print Lab Order

Print Receipt

Add Note

View Notes

View Claim

Edit Claim

Write Off

On Hold

Generate Patient Letter

Adjustment

Write Off

Billed to Patient

Claim has been billed to patient and is awaiting action.

Claim History

Preview CMS Form

Edit Claim

On Hold

Write Off

Print Lab Order

Print Receipt

Add Note

View Notes

Copy Claim

View Claim

Edit Claim

Collection

Write Off

On Hold

Adjustment

Write Off

Written Off

All or part of the receivable for the claim has been written off.

Claim History

Preview CMS Form

Print CMS Form

Edit Claim

On Hold

Write Off

Print Lab Order

Print Receipt

Add Note

View Notes

Copy Claim

View Claim

Edit Claim

Write Off

On Hold

Generate CMS Form

Write Off

Collections

Patient has been sent to collections. The Patient Balance is written off.

Note: patients who have been sent to collections are not flagged in Front Office.

Claim History

Preview CMS Form

Print Lab Order

Print Receipt

Add Note

View Notes

Copy Claim

View Claim

None

NonReceivable

At least one item exists on the claim for which the carrier will not reimburse.

Claim History

Preview CMS Form

Edit Claim

On Hold

Print Lab Order

Print Receipt

Add Note

View Notes

Copy Claim

View Claim

Edit Claim

Ready to Bill

On Hold

Preview CMS Form

Void

Ready to Bill Carrier