Understanding claim statuses

claim statuses show where an insurance claim is in the billing process and whether any action is required from you as a claim moves from creation to payment, its status updates to reflect who currently has responsibility for the next step c laim statuses explained below are the claim statuses used in eggmed and what each one means draft the claim has been created but has not been submitted the claim can still be edited no information has been sent to the payer yet this is the starting state for all new claims action required action required review and submit when ready ready the claim is complete and ready for submission all required information is present the claim has passed initial checks no payer communication has happened yet action required action required submit the claim submitted the claim has been sent to the payer the payer has not yet confirmed receipt editing is typically restricted at this stage action required action required none wait for payer response acknowledged the payer has received the claim the claim is now in the payer’s system processing has started action required action required none wait for adjudication awaiting payment the claim has been accepted and is waiting for payment the payer has completed review payment has not yet been issued action required action required none monitor until payment is received paid payment has been received for the claim the claim is complete payment can be reviewed in remittances and reports action required action required none rejected rejected the claim was rejected before processing was completed rejections are usually due to missing or incorrect information the claim can typically be corrected and resubmitted action required action required fix the issue and resubmit the claim denied the claim was reviewed by the payer and will not be paid denials occur after full review payment will not be issued unless the claim is appealed or corrected action required action required review denial reason and determine next steps voided the claim was cancelled and will not be processed or paid voided claims are closed permanently this is usually done if a claim was submitted in error action required action required none w hat to do if a claim is stuck stuck if a claim stays in the same status longer than expected check the claim details for errors review payer requirements use check status to refresh updates contact the payer if needed i mportant things to know not all claims move through every status some statuses are transitional, while others are final paid, denied, and voided are considered final states statuses update automatically based on claim activity q uick reference summary draft / ready → you control the next step submitted / acknowledged / awaiting payment → payer is processing paid / denied / voided → claim is complete rejected → action is required before resubmission