Claims
Claim status tracking
A claim's status changes when a reply file arrives. With a configured mailbox the replies are collected every 15 minutes while the background worker is running, and once a day a 276 asks the payer about claims that have waited two weeks with no answer; without a mailbox, somebody uploads the replies.
Written for: Billing and RCM teams
Where to look
ArkCloud RCM → Insurance → Claim Status
Lists claims by their current status. Insurance → Claims shows the same claims with the row actions, and each claim's detail shows its remittances and any recorded rejection or transmission error.
What moves a claim
| Field or control | What it means |
|---|---|
| 999 accepted | Submitted becomes Acknowledged. Matched on the control numbers recorded when the file was sent. |
| 999 rejected | Submitted or Acknowledged goes back to Pending, with the rejection recorded. |
| 277CA accepted | Submitted becomes Acknowledged. |
| 277CA pending | Becomes In review. |
| 277CA rejected | Back to Pending, with the rejection recorded. |
| 277 (answer to a status inquiry) | Accepted, pending and rejected move the claim exactly as a 277CA does. "Not found" is recorded and changes nothing. A 277 that says the claim was paid is recorded as what the payer said; the claim is not marked paid and no money is posted. |
| 835 posted | Becomes Paid, Partially paid or Denied from its lines - the only file that does. See the claim lifecycle. |
How reply files arrive
With the mailbox configured, the background worker (while it is running) reads its inbound folder every 15 minutes and applies each 999, 277CA, 277 and 835 to the organisation whose claims it names. Otherwise upload the files on Insurance → ERA/EOB Posting, which accepts all three. See ERA and EOB handling.
Claim status inquiry (276)
Once a day, while the background worker is running and the mailbox is configured, ArkCloud sends one 276 file per organisation through the clearinghouse mailbox. It asks about each claim that is still Submitted, Acknowledged or In review 14 days after it was submitted and has not been asked about in the previous 7 days, and records the inquiry on the claim. The payer's 277 answer arrives in the mailbox and is applied as above. A claim being voided is not asked about.
The ages are set for the whole deployment (CLAIM_STATUS_INQUIRY_MIN_AGE_DAYS, CLAIM_STATUS_INQUIRY_REPEAT_DAYS). Until mailbox credentials are entered, no inquiry is sent.