Version 14.19
The Different Claim Stages
| Stage | Meaning of Stage | When you would use this stage | What categories are in this stage? (ex: A0-A2? or Q0-Q3?) |
| Urgent Problems | - Still in Q0 status (never sent or printed) after two weeks - Still in Q2 status (never acknowledged by clearinghouse after two weeks - Still in A1/A2 status (acknowledged but never paid) after two weeks - Rejected or denied at any time (A3,A4,A6,A7,A8,F2) | To work claims sitting with no action taken (like if a Q0 claim was daysheeted and not sent, and has an insurance balance) | Various, see lists in second column |
| All Daysheeted claims (A/R) | All archived claims | When working your A/R | Could be any category |
| Not Daysheeted, new claims only | Claims that are not archived on a daysheet | When queueing your claims to the claims queue | Could be any category |
| Not Daysheeted, include payments | Claims that are not archived on a daysheet, including those with only current payments | To check for current payments on current charges | Could be any category |
| Unsent (not transmitted or printed) | Claims that are not dropped to a CMS-1500 or sent electronically to the clearinghouse. | To see what claims still need to be processed to CH | Q0 |
| In transmission queue | Claims that are sent to Claims Queue to be printed or transmitted electronically | To see that claims are ready to be printed to paper or sent electronically | Q1 |
| Transmitted, not yet acknowledged | Claims that are sent from Claims Queue with a Q2 status | To see what claims are not acknowledged from CH | Q2 |
| Printed (claim or statement) | Claims that are printed from the claims queue or printed from the patient account | To see what claims are printed | Q3 |
| Acknowledged by clearinghouse | Claims that received an acknowledgement file back from Clearinghouse | To see what claims are acknowledged from CH | A0,A1 |
| Acknowledged by payer | Claims that received an acknowledgement file back from Insurance Payer | To see what claims are acknowledged from Insurance Payer | A2,A5 |
| Denied or Rejected | Claims that are rejected internally in OP and not transmitted or claims that were rejected from Clearinghouse | To see what claims are rejected or denied internally or externally | A3,A4,A6,A7,A8,F2 |
| Pended | Claims that are pending at the Payer | To see what claims are pending at the insurance level | P0-P6,R0-R16 |
| Finalized/Paid | Claims that are finalized at payer, or paid in Office Practicum | To see what claims are finalized and or paid | F0,F1,F3,F3F,F3N,F4 |
| Uncollectable | This is used to track the uncollectable balances for patients that are in bad debt | To track the total balances sent to an U/C status and potentially use this to send to a collection agency. | FU |
| Office Responsibility | This is used to create a "queue" of claims that need to be assessed by someone in the Practice. | To track claims that need to be looked at by a defined group of staff in the Practice. | QR |
Version 14.10
The Different Claims+AR Stages
| Stage | Meaning of Stage | When you would use this stage | What categories are in this stage? (ex: A0-A2? or Q0-Q3?) |
| Urgent Problems | - Still in Q0 status (never sent or printed) after two weeks - Still in Q2 status (never acknowledged by clearinghouse after two weeks - Still in A1/A2 status (acknowledged but never paid) after two weeks - Rejected or denied at any time (A3,A4,A6,A7,A8,F2) | To work claims sitting with no action taken (like if a Q0 claim was daysheeted and not sent, and has an insurance balance) | Various, see lists in second column |
| All Daysheeted claims (A/R) | All archived claims | When working your A/R | Could be any category |
| Not Daysheeted, new claims only | Claims that are not archived on a daysheet | When queueing your claims to the claims queue | Could be any category |
| Not Daysheeted, include payments | Claims that are not archived on a daysheet, including those with only current payments | To check for current payments on current charges | Could be any category |
| Unsent (not transmitted or printed) | Claims that are not dropped to a CMS-1500 or sent electronically to the clearinghouse. | To see what claims still need to be processed to CH | Q0 |
| In transmission queue | Claims that are sent to Claims Queue to be printed or transmitted electronically | To see that claims are ready to be printed to paper or sent electronically | Q1 |
| Transmitted, not yet acknowledged | Claims that are sent from Claims Queue with a Q2 status | To see what claims are not acknowledged from CH | Q2 |
| Printed (claim or statement) | Claims that are printed from the claims queue or printed from the patient account | To see what claims are printed | Q3 |
| Acknowledged by clearinghouse | Claims that received an acknowledgement file back from Clearinghouse | To see what claims are acknowledged from CH | A0,A1 |
| Acknowledged by payer | Claims that received an acknowledgement file back from Insurance Payer | To see what claims are acknowledged from Insurance Payer | A2,A5 |
| Denied or Rejected | Claims that are rejected internally in OP and not transmitted or claims that were rejected from Clearinghouse | To see what claims are rejected or denied internally or externally | A3,A4,A6,A7,A8,F2 |
| Pended | Claims that are pending at the Payer | To see what claims are pending at the insurance level | P0-P6,R0-R16 |
| Finalized/Paid | Claims that are finalized at payer, or paid in Office Practicum | To see what claims are finalized and or paid | F0,F1,F3,F3F,F3N,F4 |
| Uncollectable | This is used to track the uncollectable balances for patients that are in bad debt | to track the total balances sent to an U/C status and potentially use this to send to a collection agency. | FU |
