PERMISSIONS: You need billing permission to view claims in the Accepted queue.
This article will help you understand what causes a claim to move out of the accepted status and what to do if that movement isn't happening.
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What causes a claim to move out of the Accepted queue?
A claim moves from the accepted queue to the paid or not paid queue in one of three ways.
Automatic attachment of a claim to an ERA
If the claim's payer has been enrolled for ERAs (Electronic Remittance Advice) then the claim will automatically move to Paid or Not Paid when the ERA is processed in Fusion, and the claim is attached.
NOTE: Occasionally, Fusion may not be able match a claim for its corresponding adjudication on an ERA. When this happens, the claim will remain in the accepted queue until it is manually attached to the ERA and information for the adjudication is saved.
Manual attachment of a claim to a remit
If the claim's payer has not been enrolled or is ineligible for ERAs, the remit must be posted manually (How to Post a Paper Remit). Once the adjudication information has been saved to the remit, the claim will move out of accepted and into paid or not paid.
Manual status change of a claim
A claim can be moved out of the accepted queue through a manual status change (How to Change a Claim's Status). However, this is outside of the normal workflow for electronic claims. Only make this change if you have additional information or if the status has been updated outside of Fusion.
What should you do if you haven't received a remit?
If you happen to have a claim that has been sitting in accepted for over 30 days, we recommend contacting the payer to identify its current status.
You can use the Dormant filter to see claims that have been sitting longer than 30 days. To find Dormant Claims:
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Go to Billing → Claims → Accepted.
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In the upper right, click the filter icon
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Select the Dormant filter.
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Click the Dormant filter that appeared to the left.
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Click on the Dormant drop-down and fill in the number of days you want to filter for inactivity. For example, “30” would show claims that haven’t had activity in at least 30 days.
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Click the Apply button.