Claims
Claim lifecycle
A claim has nine statuses. Each one is set by a specific event - a person pressing a button, or a reply file from the clearinghouse or payer. Nothing changes a claim's status on a timer.
Written for: Billing and RCM teams · Evaluators
The usual path
1ArkCloud RCM
Pending
Created by Build Claim from posted charges. Also where a rejected or reopened claim returns.
2ArkCloud RCM
Submitted
Its 837P or 837I was uploaded to the clearinghouse mailbox.
3ArkCloud RCM
Acknowledged
A 999 or 277CA accepted it.
4ArkCloud RCM
In review
A 277CA reported it pending with the payer.
5ArkCloud RCM
Paid / Partially paid / Denied
Set from the claim's charge lines after an 835 is posted.
Every status, and what sets it
| Field or control | What it means |
|---|---|
| Pending | Set when the claim is built (administrator, Build Claim). A claim returns here when the clearinghouse rejects it (999 or 277CA) or when an administrator reopens a denied claim for correction. Only a Pending claim can be submitted. |
| Submitted | Set by Submit to clearinghouse, only after the file has been uploaded to the mailbox. If the upload fails the claim stays Pending and the error is recorded on it. |
| Acknowledged | Set when a 999 or 277CA accepts a Submitted claim. |
| In review | Set when a 277CA reports the claim pending. |
| Paid | Set after an 835 is posted when the payer paid something and nothing is left open on the claim's lines - including any patient share. |
| Partially paid | Set after an 835 when the payer paid something and a balance remains on the lines. A remaining patient copay or coinsurance counts, so an ordinary paid claim with a patient share reads Partially paid. |
| Denied | Set after an 835 when the payer paid nothing on the claim's lines and assigned nothing to the patient. A claim applied entirely to the patient's deductible is not Denied: it reads Partially paid while the patient's share is open. Denial records are created only for lines the payer actually denied. |
| Appealed | Set when someone records an appeal against the claim. Recording an appeal sends nothing to the payer. |
| Void | Set when an administrator transfers the claim's balance to the patient (Transfer to patient); when the payer's 277CA accepts a void an administrator sent (see claim corrections); and on the old claim when a never-sent claim mixing prior authorizations is split into one claim per authorization. A voided claim cannot receive a remittance. |
Secondary claims
A secondary claim has its own lifecycle and starts as Pending when billing staff press Bill secondary on Insurance → Ready for secondary. It carries no charges of its own; its 837P reads the primary claim's lines and the primary payer's adjudication of each. A primary is eligible once it is Paid, Partially paid, Denied or Appealed with a balance left and the episode has secondary coverage.