Line item and Claim Status Definitions

Encounter status

ID Code Description Detailed Description
93 IMEHR Imported Encounter(s) imported from EHR/Interface
94 NEWEN New Encounter Newly created encounter, yet to be billed
95 CLMIN SentToPayer Claim sent to the payer
96 RDYTB ReadyToBill Encounter is now patient responsibility and statements are generated for the patient
97 SETTL Settled Encounter Encounter balance has been completely paid
729 RTSTP Ready to Send to Payer The claim is saved in the system
1057 CLILO Sent to Payer Leave Open A line item is left open to send an appeal to the payer
1292 DRFTE Draft Encounter These encounters won't be visible on the UI

Line Item status

ID Code Description Detail Description
1059 IMEHR Imported Encounter(s) imported from EHR/Interface
1060 NEWEN New Encounter The line item is yet to be billed
1061 CLMIN SentToPayer The claim is sent to the payer for the line item
1062 RDYTB ReadyToBill
The line item is ready to bill to the patient via a statement
1063 SETTL Settled Encounter Line item has been completely paid
1064 RTSTP Ready to Send to Payer The claim is saved in the system for the line item

Claim status

ID Code Description
39 NEWQD New
40 SENTO Sent Out
41 ERROR Errored
42 PAIDO Paid
43 RSOLV Resolved
44 CANCL Canceled
509 CHPSD Clearing House Passed
586 REJET Rejected
697 SRBER ScrubError
991 PRACT

Payer Accepted

 

Claims and encounter definitions

Encounter bucket

Unbilled 

 Unbilled (imported or manual) encounters that still need to get worked in the billing system.

Ready to Send  An encounter that has a claim associated and is ready to send to the payer.
Billed
  •  An encounter got sent to the insurance company, and it is ready to bill the patient.
  • Settled Encounters
Claim Scrubbing (In Progress)

 The Claims Scrubbing tab doesn't need review every day, but a glance is necessary if encounters are in the scrubbing process. Contact RXNT support if you're experiencing delays or issues. 

Claim Scrubbing (Corrections)

 Encounters that have not been created into a Claim

because they have corrections that need to get fixed. 

Claims bucket

To Send Electronic

Saved Claims that need to get sent.
To Print

Saved Claims that need to get printed.

Pending

Electronic submitted or printed Claims that got sent to the insurance company. 

Resolved

Claim resolved after posting a payment.

Canceled  Canceled claims.
Errored

Change Healthcare status must get reviewed to determine why Claims were kicked back by the Clearing House.  

Rejected

Rejected Claims from the Clearing House.

No Response

Claims that have not had a response in a certain time frame (it's a company preference under utilities). If you want to resubmit, remail, or contact the insurance company, this is up to you and the practice. 

Denied/Left Open Claims checked for left open is a workspace to work claim denials.
All This is an all bucket that will display all columns.

 

 

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