Glossary term
Claim status
Short answer
Claim status tells a provider where a submitted claim stands with the payer: received, in process, pending more information, paid, partially paid, or denied. Billing teams check it with an X12 276 inquiry, a payer API, a portal, or a phone call, and use the answer to decide whether to wait, fix, or appeal.
What are the common claim statuses?
Most payers report a claim as acknowledged, pending, finalized (paid, partially paid, or denied), or returned with a request for more information. In electronic responses these states are expressed as a claim status category code paired with a more specific status code.
How do billing teams check claim status?
The most scalable method is an electronic 276 inquiry sent through a clearinghouse, which returns a 277 response. When a payer’s electronic response is thin or unavailable, teams fall back to payer APIs, provider portals, or calls to the payer.
Which terms relate to Claim status?
Which guides cover this term?
Want Claimhound to check your claims for you?
Claimhound, a Veriflow Health company, checks claim status with each payer and posts EOB and 835 payment details into your billing system.