Explanation of Claim Statuses

Open: Claims that have been generated, but not submitted.

Hold: Claims that have been generated, but placed on temporary hold (for review, etc.)

                Note: Once the review is complete, the claim must be changed to "Open" status before it can be submitted to insurance.

Error: Claim that has been submitted electronically, but was unsuccessfully submitted (connection issues, processing error, etc.) If, for some reason, the claim could not be submitted, the status would automatically be updated with an "Error" status.

Processing: Claims that have been sent electronically and are being processed for submission.

Manually Submitted: Claims that have been manually submitted to insurance. Examples include:

  1. Vision Claims that are keyed into the payer’s website
  2. Paper Claims

Electronically Submitted: Claims that are sent to the payer via EDI.

Received by Clearinghouse: Claims that have been received by the clearinghouse after submission.

Rejected by Clearinghouse: Claims that have been rejected by the clearinghouse after submission.

Accepted by Clearinghouse: Claims that have been accepted by the clearinghouse after submission.

Received by Insurance: Claims that have been received by insurance after submission.

Rejected by Insurance: Claims that have been rejected by the insurance after submission.

Accepted by Insurance: Claims that have been accepted by insurance after submission.

ERA Available: Claims that have an Electronic Remittance Advice from the insurance company.

EOB Available: Claims that have a paper Explanation of Benefits available from the insurance company.

  1. This type of Remittance is created manually by the user.

Closed: Claims that have been processed and paid. Claims with a status of Closed will list the ERA or EOB number under it.

Canceled: Claims that have been canceled, users have the option to 'undo cancel' if needed