Tracking and Understanding Claim Status
Written by David Mamae
Updated at February 28th, 2025
Table of Contents
Tracking a Claim
Tracking claim in Pear Suite helps you monitor where a claim is in the billing process and take action when needed. Each claim moves through different statuses that indicate whether it is being processed, requires attention, or has been completed. Understanding these statuses ensures claims are handled correctly and efficiently.
Claim Status, the Life Cycle and What They Mean
Generated
The claim has been created after an activity was marked as billable and completed.
Error
The claim contains missing or incorrect information that must be corrected before it can proceed. Hovering over the status will display specific errors that need to be resolved.
To Resolve an Error:
- Review the listed issues and update the missing or incorrect information.
- Ensure the claim details match the payer’s requirements.
- Resubmit the claim once all necessary corrections are made.
Ready for Screening
The claim is being review before submission.
Approved
The claim has been reviewed, approved, and is ready to be sent to the clearinghouse.
Sent
The claim has been sent for processing and is awaiting for the health plan to review.
Accepted
The claim has been received and acknowledged by the health plan.
Notice: This may not indicate that payment has been made. Be sure to check the paid amount to ensure the claim has a reimbursement. If there is zero dollar reimbursement, there is a possibility the claim has been denied.
Rejected
The claim was not processed due to errors in the submission, such as incorrect coding, missing member details, or formatting issues. A rejected claim can be corrected and resubmitted.
Notice: A rejected can be resubmitted, however it does not indicate a decision on whether or not the claim will be accepted.
Denied
The insurance company has reviewed the claim and decided not to pay for it, usually due to policy reasons such as the service not being covered or not meeting medical necessity criteria.
Notice: Denied claims may require an appeal or additional documentation to be reconsidered.
Paid
The claim has been successfully processed, and payment has been received.
By understanding these statuses, you can track your claims effectively and address any necessary actions to ensure they move through the billing process successfully.