Claim Statuses

The claim status explains where the claim stands in its life cycle. Some of these statuses change automatically, but you can always change a claim status manually if need be. For example, I can mark claims on Hold for a certain payer if I am still waiting on EDI 837 enrollment with that payer. You can use the filter at the top of the Claims page to isolate claims with a certain status. You can also filter for claims of a certain status in the Billing report > Charge Status Set field. Below is a brief explanation of each claim status.

• Hold - This claim has been marked on Hold by the biller (they are waiting to submit it for some reason). A good example of why a claim might be marked on hold is when you first go live with EZDERM, you will want to mark any claim on hold that is for payers you are still waiting to complete enrollment with.
• Ready to Print - This claim is ready to be printed on a CMS 1500 form (to be mailed in). If there is no Payer ID in your Billing Settings for the payer, the claim will automatically be marked Ready to Print when the Encounter is posted.
• Ready for Electronic Submission - This claim is ready to be submitted electronically to the clearinghouse (both primary and secondary payers). If there is a Payer ID in your Billing Settings for the payer, the claim will automatically be marked Ready for Electronic Submission when the Encounter is posted.
• Ready for Patient - When an encounter is posted and the patient is Self Pay, it will be marked Ready for Patient so you can mail a statement (once sent, the status can be changed to Pending Patient).
• Pending Insurance - The claim has been submitted to insurance (either electronically or on paper) and we are awaiting our ERA or EOB (for both the primary and secondary payer).
• Appealed - The biller has appealed this claim.
• Pending Patient - The responsibility of the claim is on the patient and we are awaiting payment.
• Rejected - The claim came back rejected (the biller can correct and resubmit).
• Denied - The claim was denied (the biller can appeal or perhaps try resubmitting depending on the reason for denial).
• In Collections - The patient is in collections.
• Completed - The balance is $0 and no further action is required for this claim.