Revenue Cycle Wheel - Manage - Overview

The Manage category represents claims in your system displayed by claim status. In addition the bottom line represents claims that have been sent out and have not received any response from the payer after 7 days.  Clicking the magnifying glass on the right of any line will open the claim list for the claim status selected in the Billing Query screen.  Claim Statuses are custom defined by each practice so this category will vary from site to site; however, they can be classified as one of 5 different types.

  • Rejected Claims - Claims that were sent out and have been rejected by the clearinghouse or the payer.
  • Denied Claims - Claims that have been adjudicated by the payer and have received an EOB Denial.
  • Hold - Claims that have been placed on Hold by a user and are not to be billed at this time.
  • No Response After 7 Days - Claims that have been submitted but a response has not been received by the clearinghouse or the payer.
  • Biller Defined - All other statuses fall into this category. As practices define new claim statuses and apply them to CARC codes and specific workflows those statuses will show up here.  One example may be a CO-16 Request for Additional Information displaying in the Info. requested from office sub-category above. If you have any questions about setting up Biller Defined claim statuses for your practice please reach out to our support team.