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[MSP] What Does Each Status Mean

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What Does Each Status Mean?

Here are the meanings of each status:

Saved - Claim can be edited as it has not been submitted to MSP.

Unsubmitted - Claim can be edited. It is in the queue for upload to MSP. We submit claims once a day. Status will be changed to "Submitted" on the next business day. When an "Unsubmitted" claim is being edited, the status will be changed to "Saved"

Submitted - Claim cannot be edited as it has been transmitted to MSP for processing.

Rejected - There is a critical error with the claim which has resulted in the claim being rejected by MSP. Claim needs to be edited and resubmitted. Typical errors are missing referring physicians or invalid PHN.

Paid - Claim has been paid 100% of the submitted value.

Adjusted - Claim has been paid under or over the submitted value. For example, if you submitted a claim with a total amount of $100.00 and received payment of $99.00, then the claim will be considered an "Adjusted”.

Refused - Claim has been refused by MSP after having been processed through the adjudication systems.

Held - Claim is still in MSP's claim process and will be processed at a later date. Do not rebill the claim.

Archived - Claims that cannot be fixed can be archived for future reference. Archiving the claim allows you to keep all patient records in our system and facilitate month-end reconciliations.

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