Claim statuses and buckets

Claim statuses and buckets appear in Claims and on a patient's Claims page. In the left sidebar, click Claims. For one patient, click Patients in the left sidebar, click the patient's name, then click Claims in the patient chart. A status describes where the claim is in the submission or payment lifecycle. A bucket is a separate work queue label for billing follow-up.

Claim statuses

Use the claim status in Claims to understand where the claim is with the payer or clearinghouse.

Status	What it means
Draft	The claim is being prepared and has not been submitted.
Submitted	The claim has been submitted to the payer.
Acknowledged	The payer acknowledged the claim.
Accepted	The payer accepted the claim for processing.
Rejected	The clearinghouse rejected the claim.
Denied	The payer denied the claim.
Paid	Payment was received. A paid claim is treated as settled.

A self-pay claim may show Posted as self-pay in the claim history instead of a payer submission. That means nothing was sent to a clearinghouse, and the patient owes the full claim amount through the invoice.

Claim buckets

Use buckets in Claims to see which work queue a claim belongs to. Buckets are separate from status: the status comes from the claim lifecycle, while the bucket groups billing work.

Bucket	What it means
Untriaged	The claim has no bucket assigned.
Review	The claim is in the review bucket.
Hold	The claim is in the hold bucket.
Open / Payments	The claim is open, with payment or remittance work grouped together.
Open / Pending	The claim is open and pending.
Open / Settled	The claim is open and settled but still needs action.
Patient Billing	The claim is in the patient billing bucket.
Closed	The claim is in the closed bucket.

The board and bucket filters use this order: Untriaged, Review, Hold, Open / Payments, Open / Pending, Open / Settled, Patient Billing, Closed.

Claim alert severities

Use alert severity in a claim to decide whether you can submit now or need to fix something first.

Severity	What it means
Error	A pre-submission error blocks submission. Open the claim and correct the field or claim data called out by the alert.
Warning	A warning needs review but is not a blocking pre-submission error.
Info	An informational note about the claim.

Alerts are grouped with errors first, then warnings, then notes. Within each severity, newer alerts appear first. When an alert points to a known claim field, selecting the alert jumps to that field in the draft editor.

Claim alert sources

Use the alert source to understand where an issue came from.

Source	What it refers to
Rule	A billing rule evaluated the claim. If the rule has a name, the alert shows it after Rule.
Billing config	Organization or insurance billing setup affected the claim.
Clearinghouse	A clearinghouse response or issue.
Payer	A payer response or issue. Payer alerts may include adjustment codes such as a group and CARC code.
Claim data	Missing or invalid data on the claim itself.

Access and availability

Use Claims if you work operational or back-office billing queues.

Requirement	What it means
Role	Owners, admins, and staff can access the operational claims queue. Clinicians do not get this operational claims surface unless they also have the Owner, Admin, or Staff role.
Insurance feature	If insurance is not enabled for the organization, the Claims pages are not shown. Ona sends you back to the dashboard or patient chart.