INSTRUCTIONS:
The Claim Status Dashboard shows claims in the Electronic Data Interchange (EDI) process with a created date in the last six months. The dashboard is broken down by location and a pie chart is available for each status.
Note: We receive and process 999 acknowledgements and 277 claim status responses for all payers.
On the menu bar, click Billing, hover over Claims, and then select Claim Status Dashboard.
| Status | Definition |
|---|---|
| User Hold | An incomplete claim that has not yet been transmitted to the payer. |
| Rejected | Claims rejected by NextGen® Office (HF Rejected). |
| Accepted | Electronic: Electronic claims that are ready to be transmitted to the payer in the next batch (HF Accepted). Claims are batched at the end of the business day (PT). Paper: Paper claims that you must print on a CMS-1500 form (Paper Accepted). |
| Sent to Payer | Electronic: Claim electronically sent to payer and a 997 report (confirmation of batch delivery) or 999 acknowledgement was received. Paper: Paper claims that were printed on a CMS-1500 form and sent to the payer. After printing, you can mark that the print was successful. |
| Status | Definition |
|---|---|
| Acknowledged | Claims that were acknowledged (Received) through a claim status report (277). These reports may come from the EDI gateway or directly from the payer. A claim in the Acknowledged status does not guarantee the payer will adjudicate the claim. |
| Rejected | Claims rejected in the EDI process by the payer or the EDI gateway. |
To edit and resubmit the claim, click the dollar amount hyperlink.
| Status | Definition |
|---|---|
| HealthFusion Rejected | Claims rejected by NextGen Office. |
| Payer Rejected | Claims rejected by the payer or the EDI gateway during the EDI process. |
| Status | Definition |
|---|---|
| Received | 277 claim status report received acknowledging that an individual electronic claim has been acknowledged by the payer or another vendor. Note: If payer has not received claims, check the EOB/ERA or contact the payer for additional information. |
| Appeal | Adjudicated claims marked for appeal. |
| Denied | Adjudicated claims that were denied. |
| Finalized | If a claim is not denied and has a $0 insurance balance, the status is Finalized. Electronic: Insurance payment has successfully posted to all service lines. If no insurance payment is present, the payer may send a finalized message in the 277 claim status report. Paper: Insurance payment has successfully posted to all service lines or awaiting insurance payment posting. |
To generate a PDF of the data within each tab, click Print Status Report.
Call MPM today to schedule a Demo at 973-256-1998 x2