Claim Status Definitions - Online Claims
A single claim created online has one of 10 statuses automatically assigned to it at any given time, depending on its stage in the claim lifecycle and the payer. Depending on the current status, you can save, submit, edit, delete or print the claim.
Statuses are viewable within Claim Search, in the Status column of the list of claims that results after you enter criteria to select the claims you want to view. The displayed status (e.g., Validation Errors) can have multiple meanings. Click on the displayed status link to view a detailed status message at the top of the full claim form. To view all claims with a shared status (e.g., Submitted - Rejected), select the desired view criteria status in the drop-down list at the top of the search results page.
| Status | Displayed Status | View Criteria Status | Allowable Actions | Definition |
| Incomplete | Validation Errors | Not Submitted - Not Ready for Submission |
Save Edit Delete |
The claim has been created but is not yet complete or has been completed and errors were discovered during auto validation. |
| Complete - Invalid | Validation Errors | Not Submitted - Not Ready for Submission |
Save Edit Delete |
The claim is complete but has errors discovered during auto validation that must be corrected before it can be submitted. |
| Complete - Valid | Ready for Submission | Not Submitted - Ready for Submission |
The claim is complete, has passed through the auto edit-check without errors and is ready for submission. | |
| Submitted | Submitted | Submitted - Submitted |
The claim has been submitted; no further information is yet available from the clearinghouse or payer. | |
| Sending | Sending | NA | None | The claim is in transit to the payer or clearinghouse. This status applies only during actual transmittal. |
| Rejected | Rejected | Submitted - Rejected |
Edit Delete |
The claim was submitted and rejected by the payer due to errors. Click on the error message for details; then edit it and resubmit the claim. |
| Received | Received | Submitted - Received |
The claim has been received by the clearinghouse or payer and has passed preliminary edit checks for formatting errors. For MetLife claims, this message means the claim is undergoing auto adjudication and a real-time EOB is pending. | |
| Received - Suspended* | Received - Suspended* | Submitted - Received/ Suspended* | The claim has been suspended by MetLife. It may require further review, an attachment or provider credentialing. You will receive a real-time EOB shortly. | |
| Processed - Approved |
Processed | Submitted - Processed |
The claim has been processed and approved; payment is forthcoming. If this is a pre-treatment estimate, it can be "copied," turned into a claim and submitted one treatment is rendered. | |
| Processed - Declined |
Processed | Submitted - Processed | Edit |
The claim has been processed and declined. You can edit and resubmit it. |