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What do these claim statuses mean?
ERROR: Validation Failed: The transaction has errors that must be corrected before it can be released and sent to the payer.
MODIFIED: Modified: The transaction has been modified.
VALIDATED: Validation Success: The transaction has been validated.
RELEASED: Released: The transaction is ready to be processed by the clearinghouse. The claims are still editable and have not been batched for processing to the payers yet.
PROCESSING: Processing: The transaction has been locked by the clearinghouse for processing. Indicates that Inovalon has started processing the batch and no further changes can be made. The compiler runs Monday-Friday @ 8:00am, 10am, 1pm, 4pm, and 7pm and on Saturdays @ 8am, 10am, and 7pm.
QUEUED: Queued For Transmission: The transaction has been queued for transmission to the payer. See “Claim Transmissions to Payers and Batch Schedule”. Once claims are batched, they are then submitted to the payer.
TRANSMIT: Sent To Payer: The transaction has been sent to the payer.
REJ_PAYER: Rejected By Payer: The payer has rejected the transaction.
PAID: Paid: The payer has paid the transaction. View remittance for additional information.
DENIED: Denied: The payer has denied the transaction on a remittance advice.
Problem: Special Characters In Insurance Company Name
Any special characters such as parentheses and other symbols in the Insurance Company name in MacPractice (References > Insurance Companies > Company Info Tab > Insurance Name) will cause claims to be stopped.
To resolve this, simply remove any special characters from the Insurance Name in MacPractice.
Rejection: Provider Not Enrolled
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In general, there are three steps to take when experiencing Provider not Enrolled rejections:
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In addition to this, you’ll also want to double check the References Ability > Insurance Companies node, and expand this to select the insurance company payer in your sidebar. Once you’ve selected the payer in question, you’ll click on the Provider IDs Tab and ensure the “Legacy Type Override” is set to “Use User Reference”.
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Rejection: Submitter not Approved
These rejections are not always related to enrollment, but we recommend the following steps:
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