Claim statuses

A claim's status indicates where the claim is in the claim processing cycle. You will see the claim status on various claim displays as well as on the claim session data tile. If an * displays, point to it to display additional values.

Claim Status	Description
A	Adjustment—The original claim that was adjusted.
AA	Adjusted adjustment claim.
AHI	Adjusted Historical Claim
AP	Adjusted Paid claim
APH	Adjusted Paid Hand Issue
APR	Adjusted Payment Refund
AR	Adjusted Released
HA	Held for Audit—Refer to the Pends/Audits table field descriptions for the audit codes associated with a claim. See Claim information.
HI	Historical Claim—updates accumulators only- no checks or Explanation of Benefits
HP	Held /Pended—The claim is "on hold". Refer to the Pends/Audits table field descriptions in Claim Information for the pend codes associated with a particular claim. See Claim information.
IP	In Progress—This status shows while a claim is being entered into the system. After the claim is entered, the status will change to HP, HA, or R.
O	Outstanding
P	Paid—a check has been issued for this claim.
PH	Paid Hand Issue
PR	Payment Refund
R	Released—This claim is awaiting the check run process and no check or EOB EOBs are sent to members and payees to inform them of the disposition of claims. Typically an EOB identifies the date and type of service, the billed amount, deductibles, co-insurance, and an explanation of any ineligible charges. An EOB can also be a helpful tool in identifying fraudulent claims, as the member receives notification even when payment is made to the provider. An EOB isn't a bill. has been issued for it yet.
SU	Summarized
V	Void. A voided claim.
VP	Voided Paid (check)
VPH	Voided Hand Issue—The voided claim has a hand-issued check associated with it.
VPR	Voided Payment Refund
VV	Voided Void
W	Waste Check A designation used for checks that are voided and were not printed (e.g. checks used to test the printer).