Description
This quick guide describes the different claim statuses.
About
The claim status shows on the claim row in the Billing module and in the Claims module. These are the available filter options to sort claims by status in the Claims module. Understanding these definitions helps dental teams accurately track the lifecycle of their insurance claims and identify where action may be required.
- In Batch
The claim has been created but is not yet scheduled to send.
- Scheduled to Send
The claim has been created and is scheduled to be sent electronically overnight.
- Sent
The claim has been successfully transmitted to the clearinghouse.
- Submitted
The claim was received and potentially accepted into the carrier's adjudication system. Claims may be split upon acceptance into the adjudication system.
- Processed
The claim was processed for primary, secondary, or tertiary insurance and may have been forwarded to additional payers.
- Rejected
The claim was rejected and not entered into the adjudication system. Common reasons include field errors, missing information, or invalid data as specified in the Status Details.
- Payer Pended
The claim has been submitted and is currently waiting on the carrier for further action.
- Additional Info Required
The claim was submitted, but the carrier requires additional information to proceed.
- Error During Submission / An Error Occurred
An error was reported by the clearinghouse during transmission, or an unknown system error occurred.
- Manual
The claim was printed manually and was not sent electronically.
- Cancelled
The claim was manually cancelled by a user within the office.
- Claim Reversed
Indicates the reversal of a previously submitted claim.
- Forwarded
The claim was forwarded to another entity or an additional payer for processing.
- Waiting for Attachment
An attachment for the claim has been created in NEA FastAttach but has not yet been sent.
- Error Creating Attachment
An error occurred during the attachment creation process.
- Invalid
The claim is considered invalid by the system or clearinghouse.
- Payment Exception
The claim was sent, but the payment could not be automatically posted. User interaction is required to resolve the discrepancy.
- Exception Cleared
A previously identified payment exception has been resolved and cleared by a user.
- Paid (Automatic)
The claim was sent and the payment was successfully posted to the ledger automatically.
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