Claim and Line Item 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 Screen) |
Actions (Claim Detail Screen) |
Buttons (Claim Detail Screen) |
Line Item Actions |
|
Ready to Bill
See also Setting the Claim Status to 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 |
|
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 |
|
|
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 |
|
|
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 |
|
|
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 |
|
|
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 |
|
|
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 |
|
|
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 |
|
|
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 Statement Edit Claim On Hold Write Off |
Print Lab Order Print Receipt Add Note View Notes |
View Claim Edit Claim Write Off On Hold Generate Statement |
Adjustment Write Off |
|
|
Claim has been billed to patient and is awaiting action. |
Claim History Preview CMS Form Generate Statement 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 Generate Statement |
Adjustment Write 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 |
|
|
Patient has been sent to collections. The Patient Balance is written off. Note: The patient's collections status is not indicated in their record in Front Office. Collections status does not automatically send information to a collections agency. |
Claim History Preview CMS Form |
Print Lab Order Print Receipt Add Note View Notes Copy Claim |
View Claim |
None |
|
|
NonReceivable status means that 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 |