Billing Applet Claim Bucket Definitions

Billing Applet Claim Bucket Definitions

Introduction

A description of each of our claim buckets and the claim types they contain

More Information

Bucket

 

Status

 

Description

 

For Follow-up

 

 


 

 

 

 

 

 

Statements Not Going

 

Claims for accounts with statements on hold. Also includes accounts where pre collection cycle is completed.

 

 

 

 

Neglected Svc Details

 

Claim lines that have not been submitted

 

 

 

 

Pending Rebill

 

Claims that have been tagged for rebill that need editing

 

 

 

 

On Hold

 

Claims that have been placed On Hold

 

 

 

 

Credit Balances

 

Any claim with a credit balance on a line item

 

 

 

 

EHR Imports

 

Claims imported from your electronic health records system

 

 

 

 

Denied Svc Details

 

Denials posted, and claim line not resubmitted yet

 

 

 

 

Pending

 

Any claim detail that has had transactions posted to it, but has not yet been resubmitted to a new debtor (when it is resubmitted, it will be removed from pending status)

 

Errors

 

 

 

 

 

 

 

 

 

 

EDI Claim Errors

 

Claims that fail PA's EDI edits when claim file is created

 

 

 

 

EDI Rejections

 

Claims that have been rejected by Payer

 

 

 

 

Pmt Processing Errors

 

Payment could not process due to error.  Open payment application and click "unposted button"

 

 

 

 

Import Errors

 

Claims with import errors

 

 

 

 

Processing Errors

 

Claims with errors

 

 

 

 

Concurrency Errors

 

Anesthesia claims that exceed concurrency limits

 

 

 

 

Show All

 

Shows all statuses for the Error bucket

 

Awaiting release

 

 

 

 

 

 

 

 

 

 

Pre-Released

 

Claims with incomplete information, or claims that the user does not want to submit immediately

 

 

 

 

For Review

 

Claims that are ready for review

 

 

 

 

Concurrency

 

Anesthesia claims that require concurrency processing

 

 

 

 

Show All

 

Shows all statuses for the Awaiting Release bucket

 

 

 

 

 

Released

 

 

 

 

 

 

 

 

 

 

Awaiting EDI Submission

 

Claims that are waiting to be submitted by EDI

 

 

 

 

Awaiting Printing

 

Claims that are waiting to be printed on a HCFA form

 

 

 

 

Pending Statement

 

Self Pay claims, or claims transferred to the patient, where a statement has not yet gone

 

 

 

 

Pending Invoice

 

Industrial Account claims where an invoice has not been sent yet

 

Submitted

 

 

 

 

 

 

 

 

 

 

In EDI File

 

EDI file has been created, and is pending transmission.

 

 

 

 

EDI File In Transit

 

EDI File is being processed by the EDI servers

 

 

 

 

Submitted by EDI

 

EDI file has been successfully transmitted, no confirmation received from payer yet

 

 

 

 

EDI File Confirmed

 

Payer has confirmed that the EDI file has been received

 

 

 

 

EDI Confirmed Claims

 

Positive confirmation has been received from the payer system that the claim has been received and accepted for processing

 

 

 

 

Medicare Crossover

 

Medicare payment file shows that claim was crossed over to secondary payer

 

 

 

 

Submitted by Mail

 

Claims printed by user on local computer

 

 

 

 

Billed to Patient

 

Self Pay claims with statement sent OR

 

 

 

 

Claims transferred to patient, and statement sent

 

 

 

 

Billed to Industrial

 

Industrial Account claims where an invoice has been sent

 

By Patient

 

 

 

 

 

 

 

 

 

 

By Patient (OS Claims)

 

Shows all outstanding claims for the patient selected in the patient combo box on claim general, or the patient name selected on PA Today (which would override any patient name on the claim general form)

 

 

 

 

Changes the columns in the grid to be DOS/Claim ID/Balance/claim status/status date

 

 

 

 

By Patient (All Claims)

 

Shows all claims for the patient selected in the patient combo box on claim general, or the patient name selected on PA Today (which would override any patient name on the claim general form)

 

 

 

 

Changes the columns in the grid to be DOS/Claim ID/Balance/claim status/status date

 

 

 

 

 

All Claims

 

 

 

 

 

 

 

 

 

 

All Outstanding

 

All claims with an outstanding balance

 

 

 

 

All

 

All Claims

 

Processing

 

 

 

 

 

 

 

 

 

 

Awaiting Pmt Processing

 

Payments that are waiting to be applied to the account

 

Collections

 

 

 

 

 

 

 

 

 

 

Collections - O/S

 

Claims transferred to collections, but not written off

 

 

 

 

Collections - W/Off

 

Claims transferred to collections, and written off

 

Inactive

 

 

 

 

 

 

 

 

 

 

Paid

 

Paid claims, or any claims that have a $0 balance as a result of posted adjustments or write-offs

 

 

 

 

Old (Txfer/Resub/W-O)

 

For claims that have been fully adjusted off via the resubmit or transfer to secondary processes

 

 

 

 

Voided

 

For claims that have been voided

 

 

 

 

 

 

 

 

 

 

 

 

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