In TiQ, you’ll see different claim statuses as you work with claims. Here’s a simple explanation of each one:

Pending – This is when a primary claim has been created but has not been submitted yet.

Pending Primary – This is when a secondary claim has been created and is waiting for the ERA from the primary claim before it can move forward.

Ready to Submit – Once the ERA for the primary claim is received, the secondary claim will move to this status and is ready to be submitted.

Submitted – The claim (primary or secondary) has been sent to the clearinghouse for processing.

NOTE: After a claim is submitted, if an ERA is received through TiQ, the status will update automatically. If you receive payment outside of TiQ, you can update the claim status manually.

Paid – The insurance payer has processed the claim and made a payment.

Rejected – The claim has errors and was stopped by the clearinghouse before being sent to the payer.

Denied – The claim was sent to the payer, but the payer declined payment.

Deductible – The claim received an ERA with a $0.00 payment because of the client’s deductible.

NOTE: The statuses Paid, Denied, Rejected, and Deductible only apply after a claim has been submitted.

IMPORTANT: If a claim is marked as Deductible and ERA Auto Posting is enabled, TiQ will not automatically post CO adjustments to the ledger. If needed, these can be added manually.