Statuses
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 | The claim was sent to the payer |
| 96 | RDYTB | ReadyToBill | Encounter is now the patient's responsibility, and statements are generated for the patient |
| 97 | SETTL | Settled Encounter | The 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 | Detailed 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 | The 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 | Detailed Description |
|---|---|---|---|
| 39 | NEWQD | New | A new claim has been created |
| 40 | SENTO | Sent Out | The claim was sent out electronically or printed |
| 41 | ERROR | Errored | There was an error for the claim |
| 42 | PAIDO | Paid | The claim has been paid |
| 43 | RSOLV | Resolved | Claims are considered resolved when the claim balance reaches zero. Each level of insurance, primary, secondary, and tertiary claims has there own separate claim. As responsibility moves to the next payer, a new claim is generated and remains open until resolved |
| 44 | CANCL | Canceled | The claim has been canceled and will appear under the Canceled tab |
| 509 | CHPSD | Clearing House Passed | The clearinghouse has accepted and sent the claim to the payer for review |
| 586 | REJET | Rejected | The claim has been rejected by the clearinghouse or payer and will appear under the Rejected tab |
| 697 | SRBER | ScrubError | Once the claim has been scrubbed for errors, any errors found will appear in the Corrections Required |
| 991 | PRACT | Payer Accepted | The claim has been accepted by the payer |
Claims and encounter definitions
Encounter definitions
- 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 was sent to the insurance company or patient.
- Claim Scrubbing In Progress:
- The Claims Scrubbing tab doesn't need reviewed every day, but a glance is necessary if encounters are in the scrubbing process.
- Claim Scrubbing Corrections:
- Encounters that have not been created into a Claim due to corrections that need to be fixed.
Claims definitions
- To Send Electronic:
- Claims that need to be submitted electronically.
- To Print:
- Claims that need to be printed and sent out.
- Pending:
- Claims sent electronically or printed that were sent to the insurance company.
- Resolved:
- A payment that brings an active claim's balance to zero marks it as resolved, and it is no longer included in AR calculations.
- Canceled:
- The claim has been canceled.
- Errored:
- Change Healthcare status must be reviewed to determine why the Clearing House kicked back claims.
- Rejected:
- Rejected claims from the clearing house or payer.
- No Response:
- Claims that have not had a response in the timeframe selected under the utilities company preference.
- Denied/Left Open:
- Claims that have been denied by the payer and left open for review.
- All:
- The All tab displays all the claims no matter their status for the selected timeframe.