Depending on where in the claiming process an activity is, it will report its most recent Invoice (claim) status. Some statuses are specific to manual billing while others apply only to EDI processing. These statuses are explained below.
Description | Notes | Can Be Corrected? | Invoiced? | Locked? |
Ready For Manual Invoicing | Claim is locked and ready to be manually invoiced. | No | Yes | Yes |
Submitted | Claim has been submitted to the payer. | No | Yes | Yes |
Approved-Void Requested | (EDI) A request is scheduled to be made to void the approved activity. | No | Yes | Yes |
Approved-Void Pending | (EDI) Waiting on the response for the void request. | No | Yes | Yes |
Approved-Void Failed | (EDI) The void request failed. | No | Yes | Yes |
Approved-Void Finalized | For EDI, the void request was accepted; the once-approved claim is now voided. | No | Yes | Yes |
Void-Correction Requested | (EDI) A request is scheduled to be made to void the approved activity in order to make corrections. | No | Yes | Yes |
Void-Correction Pending | (EDI) Waiting on the response for the void request. | No | Yes | Yes |
Void-Correction Failed | (EDI) The void request failed. | No | Yes | Yes |
Void-Correction | The void request was accepted; the once-approved claim can be corrected. | Yes | Yes | No |
Void-Resubmit | The voided activity has been corrected and is waiting for resubmission. | No | Yes | Yes |
Denied | The claim was denied by the payer. For EDI, this means a 277 or 835 denied request was received, or a record from rpt_dmhclaim matching the claim number has a status of Denied. | No | Yes | Yes |
Denied-Void | The denied claim to the payer is voided. | No | Yes | Yes |
Denied-Correction | The denied claim to the payer is being corrected. | Yes | Yes | No |
Denied-Resubmit | The denied claim to the payer has been corrected and is waiting for resubmission to the payer. | No | Yes | Yes |
Paid | The claim has been paid by the payer. | No | Yes | Yes |
Rejected-Not Submittable | The claim contains problems that prevent it from being invoiced. | No | Yes | No |
Pending-Received by Payer | (EDI) A 277 response has been received by the payer. | No | Yes | Yes |
Rejected-Pending Resubmission | A rejected message has been fixed and is pending resubmission. | No | Yes | Yes |
Ready for EDI Invoicing | Claim is locked and ready to be invoiced electronically. | No | Yes | Yes |
Rejected on Receipt | (EDI) The claim was rejected on receipt (997). | No | Yes | Yes |
Closed - No Charge | The No-Show or No-Charge activity has been closed and was not billed. | No | Yes | Yes |
Pending-Not All Group Activities Submittable | This activity is ready to submit, but one or more of the associated group's activities are pending due to submit errors (missing DOB, SSN, etc.). |
|
|
|
Pending CPE | (EDI) The claim is being held because the provider is either at or near Maximum Contract Amount. Contact your DMH liaison. | No | Yes | Yes |
Note: Please be aware that an invoice status is not the same thing as a note status. Note status indicates whether the note related to an activity has been started, is in the process of being written, or has been completed and submitted for review and/or approved. Invoice or claim status reports where that same activity is in the billing/reimbursement process.
Activities for clients missing critical claims processing information will appear on either the Activities Needing Attention or Claims with Problems Preventing Invoicing screens.
Claim Problem List (incomplete):
Patient Payor Accounts:
No payer is defined for this client
No Patient Payor Account Covering Dates of Service
Red Status Funding
The clients funding status is red (expired)
Required Note Not Yet Approved
The note for this activity is not yet approved
Claims with Problems
Waiting on other group claims, denied, waiting on corrections