Claims go through various statuses depending on their stage of processing. These statuses help you quickly identify the claim's stage and easily sort through claims while working on them.

Here's a breakdown of each claim status: 

• Hold: used primarily for personal injury or worker's compensation claims awaiting finalization
• Waiting: claims on purchases with downstream (secondary or tertiary) payors where we must wait for a response from the upstream (primary) payor before generating and submitting the claim. Once the upstream payor's status is updated to denied or paid, the waiting claim will automatically move to pending.
• Pending: claims need to be generated but is missing required information (use the Test button to test claims against ChiroUp business rules, ensuring all required information has been entered). 
• Unsubmitted: claim is ready for generation, has passed ChiroUp business rules, and all there is left to do is submit the claim. 
• Submitted: claim has been generated, recorded as submitted, and is awaiting response from the payor.
• Received: claim has been received by the payor [this is an automatic status for TriZetto subscribers].
• Rejected: claim was either rejected by the clearinghouse or payor due to inaccurate or missing information— claim will need to be regenerated [this is an automatic status for TriZetto subscribers].
• Denied: payor denied the claim; they will not pay services due to coverage or policy limits  [this is an automatic status for TriZetto subscribers].
• Partial: partial payment has been received for this claim, awaiting another payment from the payor. 
• Paid: full payment has been received and claim is “closed.”