How to Update the Status of a Claim

To update the status of an electronic claim:

1. From the Location tab, select Claims > Claims Management. The location's claims are displayed.
   Note: You can also access claims from the Patient tab (Patient > Insurance > Claims Management).
2. Use the filters, as needed, to find the claim you want to update.
3. Select the claim in the list. The Claim Summary is displayed.
4. Click Update Status. The Adjust Claim Status window is displayed.
5. Select a status from the New Claim Status drop-down list.
   
6. Enter a comment in the Status Change Note field.
7. Click Update.

Claim Statuses Updated Automatically Based on eClaims Reports

In some cases, the status of electronic claims are automatically updated based on the results received in eClaims Reports (Location > Archives > eServices Reports), particularly the Claim Status Reports:

• Claims that have a response of Rejected or Final Rej are automatically updated to a Rejected status in the Claims Management list.
• For claims that are marked as having an error, the claim status is automatically updated to Error.
• If the claim response is Acceptance or Final Acc, the claim status is automatically updated to Accepted.
• Responses of Warning or Pending are not handled automatically.
• Terminal states such as Paid, Denied, Closed, or Completed are not automatically overwritten.

Note: 
-- When a report includes multiple status updates for the same claim, the status of the claim is determined based on the highest-ranking status, with the statuses being in the following hierarchy: Final Rej, Rejected, Error, Final Acc, Accepted, Warning, and then Pending.
-- You are still able to manually update claim statuses as needed.