Short List Version of All Statuses:
Pending: Initial status of claims - when a billable encounter is created a claim is created in this status
Ready to Bill: Manual status when a user is ready for a claim to be generated - Generate Claims screen looks for claims in this status by default
Generated: Interim status of a claim from Generate Claims screen when generation of the EDI claim format is successful, but the claim has not been transmitted yet
Generation Errored: Claim status when generation of the EDI claim fails - View Status History to see error reason
Transmitted: Claim has successfully been transmitted to the Clearinghouse for distribution/delivery to the payor
Transmission Errored: **Not used yet, but meant to be used if we get a report back from the CLearinghouse that it was rejected and not distributed/delivered to the payor
Cancelled: **Not used yet
Generated Paper: Generated from Generate Claims screen, but the format was paper and not one of the EDI formats
Errored Paper: **Not used yet
Printed Paper: Status when the user says to print on HCFA 1500 form
Sent Paper: Manual status for use on Generate Claims screen for when you generate Paper and want to mark as Sent
Transmission Verified: **Not used yet, but meant to be used if we get a report back from the Clearinghouse that it was successful and distributed/delivered to the payor
No Bill: Manual status used for marking claims as not transmitting (i.e. Self Pay claims, but does not avoid Patient Statements to pull these in) Also used as a way to get claims out of AP statuses in the past (now we have new statuses that ReLiMed Billing uses)
Suspended: Manual status used to keep a claim out of Patient Statements *Note, we now have the "Mark No Statement" on Edit Claims to do the same thing
Closed: Automatic and manual status (only allowed when balance is $0) to indicate no payor or patient balance exists on a claim
AP Skipped: Automatic status from the Auto-Posting process. This means that one or more transactions (adjustments and/or payments) were skipped based on the reason code and how it is set up in the system configuration. Can also happen when Admin -> Location -> Preference of "Post Payments with Negative Amounts" is UNCHECKED and the claim payment amount is negative. Reason in Claim Status will show "Negative Payment"
AP Denied: IF the Claim Status on the ERA itself says: Denied AND under Admin -> Location -> Preferences the option "Post Denied Claims" is UNCHECKED meaning users do not want Auto Posting to auto post Denied claims, we will skip the claim and change the status to "AP Denied"
AP Failed: Claim will be put in this status if reasons of "Claim Not Found" or "Patient not Found" you have to look at Status History and reason to see which one. It could be we could not match the claim number or the patient name for some reason
AP Negative Balance: Claim will be put in this status when the Payor Balance ends up as a Negative amount (payor credit)
Follow up: Manual status added by Relimed to be used to flag claims that need follow up at a later time
Detailed Explanation of AP Skipped:
AP Skipped status means that one or more transactions (adjustments and/or payments) were skipped based on the reason code and how it is set up in the system configuration. You can certainly set it to auto post every reason code, but we have it set up in a default way so then the claims that end up in AP Skipped can be reviewed and if they need to be refiled, that can be done. Otherwise, they would be adjusted off fully and the claims would go unpaid.
You can always check the reason a claim went to AP Skipped by looking on the Claim Status History (Hx button) and then hover over the Claim Error column. Below is an example from your Claims Search on Status = AP Skipped says due to OA-18. Our system will mark the claim AP Skipped when it encounters a reason code for an adjustment that is set up as “Do Not Post” so that it will skip that transaction:
You can then see under Admin -> Lists -> List Item Entry for the “Billing Auto Post Reason Codes”, that 18 is set to Do Not Post. You can change this to “Post as Adjustment” and then the next time it will auto post as an adjustment. To change it, just click on the “Do not post” and change it to “Post as Adjustment” The idea behind Do Not Post is that it may need to be brought to your attention.
