Claim Status Glossary

  • Finalized - the claim has been processed and a payment determination has been made. This payment determination may or may not result in an actual payment based on claim or enrollee eligibility, benefits or previous payments related to this claim.
  • Finalized/Revised - the original processed claim has been changed based on new information.
  • Pending/In Process - the claim has been received and entered into the claims system. It is currently awaiting additional information and/or review by a claims examiner.