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Claim Statuses

Claim Statuses and What They mean

TermDefinition
Suspended Held for additional information.
Pending Held for pending review.
Rejected/Denied A rejected claim is an electronically submitted claim that is not processable due to missing or invalid information required by the payer.
Invalid Any Medicare claim that contains complete, necessary information but is illogical or incorrect (e.g., listing an incorrect provider number for a referring physician). Invalid claims re-identified to the provider and may be resubmitted.
Approved A claim that was checked by and validated by an insurance company, then payment is given to provider from the insurance company.
Created by: cattomko
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