Understanding claim statuses

A claim can have various statuses during its lifetime. Statuses can vary by payer.

Stage 1 - You create the claim in Dentrix Ascend:

• Unsent (UNSENT).

Stage 2 - You submit the claim electronically. Possible statuses:

• Queued (QUEUED).

• Sent (SENT).

• Resubmitted (RESUB).

• For a claim without attachments (or if the payer does not accept attachments):

  • Received (RECEIVED) - The initial status.

• For a claim with attachments (if the payer accepts attachments):

  • Attachment Hold (NEAHOLD) - The ID for the attachment was requested.

  • Attachment Error (NEAERROR) - The attachment ID was not received.

  • In Transit (EXTRACTED) - The claim was extracted and sent to the clearinghouse.

  • Rejected by eServices (REJECTSV) - The claim did not pass validation upon extraction.

Stage 3 - Dentrix Ascend sends the claim to the clearinghouse. Possible statuses:

• Accepted (ACCEPTED) - The clearinghouse received the claim. (If the payer does not provide status updates, this is the final status; ignore stage 4.)

• Rejected by Payer (REJECTED) - The claim failed validation.

• Unprocessable Claim (UNPROCESS) - The claim could not be processed, which is similar to Rejected.

Stage 4 - The clearinghouse forwards the claim to the payer. Possible statuses (if the payer provides any status updates):

• Accepted (ACCEPTED).

• Rejected by Another Entity (REJECTED).

• Unprocessable Claim (UNPROCESS).

• Paid (PAID) - The payment was sent by the carrier but not received by your office.

• Zero Payment (ZEROPAY) - Zero or no payment.

• Additional Information Requested (ADDINFO) - Additional information is needed.

• Pending (PENDING).

• Settled (SETTLED).

Stage 5 - You enter the insurance payment (for zero or more dollars) in Dentrix Ascend:

• Payment Received (PAYRECVD).

Other possible statuses:

• Printed (PRINTED).

• Deleted (DELETED).

• Voided (VOID).