Use this status when a payer denies a claim and requires corrections before resubmission. This means you are fixing an error on the original claim and resubmitting it to the same payer, not sending it to a new one.

• Line item fields cannot be edited in this status.
• Line items remain under the current payer’s responsibility and the claim is moved to the Denied / Left Open tab

For example, a claim may need to be corrected and resubmitted for reasons such as:

• A missing or incorrect modifier (for example: 25, 59, 16, GP, GO, GN)
• An invalid or outdated diagnosis code
• A missing or incorrect authorization number
• The provider’s NPI is not yet credentialed
• A timely filing denial that you are correcting and resubmitting 
• An incorrect place of service or procedure code

Use this status when a payer has partially paid a claim but denied one or more line items that require correction. The payment already received is kept, and the corrected line(s) are resubmitted to the same payer. 

• Line item fields remain editable.
• Line items stay under the current payer’s responsibility, and the claim moves to the Denied / Left Open tab.

For example, a claim may be partially paid when one or more line items are denied while others are paid, such as:

• One CPT code is paid, while another is denied due to a missing modifier
• An office visit is paid, but a related procedure is denied because authorization was missing 
• Part of the allowed amount is paid, while remaining service lines are denied 
• One service line is denied due to bundling and must be corrected and resubmitted

Select this status for line items that have not yet received payment because the payer is still processing or reprocessing the claim. The claim remains with the payer, you are waiting for their action, and no new claim submission is required. 

• Line item fields cannot be edited, keeping responsibility with the current payer and moving the claim to the Denied / Left Open tab

For example, a claim may remain pending or under review in situations such as:

• You spoke with the payer, and they are reprocessing the claim
• A denial was overturned during a phone call with the payer
• The claim has been placed back into adjudication
• The payer requested time to review documentation you already submitted
• Partial payment was made, while the remaining balance is still under review
• The ERA shows an informational or pending status.

Use this status when no data entry or correction is required for a line item. This applies when the payer responded to a billed service line, paid zero amount (or bundled it), and you are not resubmitting or correcting that line item.

• Line item fields cannot be edited.
• The line item remains under the current payer’s responsibility and the claim is moved to the Denied / Left Open tab

For example, use this status for line items that require no further action. Typical situations include:

• Bundled into another service - A CPT line item shows a $0.00 payment with a denial code stating it was bundled into another procedure, while a different CPT on the same claim was paid normally. Because the payer has already applied their bundling rules correctly, the bundled line item should be set to Ignore Line Item. No rebilling or follow-up is required, and the line item should not remain open.
• Non-covered service you are not rebilling - A CPT line item pays $0.00 and includes a remark indicating the service is non-covered by the payer. Since the service will not be corrected or resubmitted, the line item should be set to Ignore Line Item. The balance may be billed to the patient or written off according to office policy. No further payer action is needed. 
• Duplicate or information denial - A CPT line pays $0.00 with remark indicating the service is a duplicate or was previously processed. Because the payer is not requesting additional information or a correction, the line item should be set to Ignore Line Item. A resubmission is not appropriate, and the claim should not remain open for this service. 
• Payment applied to another line item - One CPT on the claim shows payment, while another CPT shows $0.00 with a remark explaining that payment was applied to the primary or related service. Since the financial outcome is already reflected on the claim, the $0.00 line item should be set to Ignore Line Item. No follow-up with the payer is required. 

Use this status when the claim is still being worked by the same payer and no corrected claim needs to be submitted. This status helps prevent premature secondary billing, duplication submissions, and AR bouncing between payers. 

• Line item fields cannot be edited in this status.
• The line item moves to the next payer’s responsibility without placing the claim in the Denied / Left Open tab.

For example, use this status for line items where responsibility should remain with the current payer. Typical situations include: 

• Payer reprocessing after follow-up - After contacting the payer regarding a denial or underpayment, the payer confirms the claim has been reopened for reprocessing and no corrected claim is required. Because the payer is still working the claim and will issue an internal correction, the affected line items should be set to Awaiting Payment while you wait for the updated ERA.
• Denial overturned without resubmission - A CPT line shows a denial or $0.00 payment on the ERA, and the payer later confirms the claim was processed incorrectly and will be corrected. Since no new claim submission is needed and the payer will automatically issue an update payment, the line item should be set to Awaiting Payment.  
• Partial payments still under review - Some CPTs on the claim have been paid, while others remain pending or are marked for review by the payer. Because the [ayer is still processing the unpaid services and rebilling is not appropriate, those unpaid line items should be set to Awaiting Payment. 
• Documentation review in progress - Medical records or prior authorization documentation have been submitted, and the payer confirms the review is still in progress. Since the payer will complete adjudication without requiring a corrected claim, the affected line items should be set to Awaiting Payment.
• Claim still in process - The ERA or payer portal indicates the claim is “in process” or “not finalized.” Because the claim has not yet been resolved and responsibility remains with the payer, the line item should be set to Awaiting Payment.