Claim line level statuses
Claim line statuses in Smart Claims Engine are displayed on the claim line and also in the claim line details section of the claim.
Pega Marketing User Guide
Claim line statuses are a single word indicating the status of the individual claim line. Claim line statuses include:
Claim line status | Definition |
New | This is the initial status of claim lines and it indicates the line has not yet been adjudicated. |
Pending | This status is assigned when the claim line has generated an event code which requires additional processing or examiner intervention. |
Denied | This status indicates that the service billed by the provider is disallowed. |
Approved | This status is set when the service billed by the provider is allowed. |
Paid | This status is assigned when the service billed by the provider is approved and payment batch has been completed. |
Voided | SCE assigns this status when the claim line has been invalidated or “backed out”. All associated accumulators are reversed. |
Cancelled | SCE assigns this status when the claim line has been annulled; this is also the status applied to an original claim line when it has been split into two or more claim lines. |
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