Claim statuses
Every claim carries a status that tracks it from creation to payment. The Claims tab of the Insurance hub can be filtered by any of them.
The lifecycle
| Status | What it means | What to do |
|---|---|---|
| Prepared | Created but not submitted — you can still edit or delete it | Review and submit, or file it externally |
| Submitted | Sent to the clearinghouse, awaiting payer pickup | Wait — most payers acknowledge within days |
| Filed externally | You billed this outside the platform; tracked for records only | Update it manually as the payer responds |
| Accepted | The payer accepted the claim for processing | Wait for adjudication |
| In Review | The payer is adjudicating | Wait; follow up if it lingers |
| Info Requested | The payer wants additional information | Provide it, then track the response |
| Pending | Adjudicated but not yet finalized/paid | Watch for the ERA |
| Paid | Payment posted — see Payments & ERAs | Reconcile any client responsibility |
| Deductible | Processed, but the allowed amount went to the client's deductible | Bill the client |
| Rejected | Stopped before adjudication (clearinghouse or payer front-end) | Fix and resubmit |
| Denied | Adjudicated and refused | Appeal or correct |
| Voided | Cancelled with the payer (frequency code 8) | Nothing — it's closed |
Claims that have been sitting submitted for more than 30 days are flagged in the list — if a claim goes quiet that long, check the payer portal or call, and confirm the claim wasn't lost (this is sometimes called "investigating missing payments"; the fix is the same everywhere: confirm receipt, confirm the check/ERA destination, and resubmit if the payer never got it).
Checking on a specific claim
Open any claim from the Claims tab. One button at the top is the claim's next step (Submit to Payer on a Prepared claim, Create Corrected Claim on one the clearinghouse has taken), and the arrow beside it holds the rest: Edit, Mark as Filed Externally, Check Status, Create Secondary Claim, Void, Write off and Delete, each only when it applies. Proof of filing is on the History tab. Insurance payments are recorded from Insurance → Payments, not from the claim. Under the button sits anything that needs fixing: a rejection or denial with the payer's reasons (See all reasons opens the step-by-step list), a payer's request for more information, or a claim sent to the wrong plan. Below them are four tabs, and the claim opens on the first:
- Claim form — the claim drawn on the standard CMS-1500 (also what you print for external filing)
- Status — payments per service line and payer responses
- History — the full timeline of everything that's happened to this claim
- Claim notes — your internal notes on the claim (great for documenting payer phone calls)
Claims carry two reference numbers, shown at the top of the claim's detail page: the clearinghouse reference (assigned when the claim is submitted) and the payer claim number (the payer's own number, filled in once they acknowledge the claim, and again from their remittance). The Claims tab lists the payer claim number. Payer support will ask for these when you call, and the payer claim number is what a void or corrected claim must quote.
The hub's Needs Attention count is specific: rejected, denied, and info-requested claims, plus deductible claims whose contractual balance hasn't been settled yet.