A status that says pending is not an answer.

Send claim status requests by batch file or API. A status request fails when the patient detail on it does not match the payer's record: a leading zero dropped from a member ID, a name spelled the way the registrar heard it. A rules engine corrects those errors before the request goes out.

The response comes back with the allowed amount, the patient responsibility and the payer's denial description in words, with the appeal pathway identified, so the claim can be worked without a call.

A standard claim status response says whether a claim was received, is pending or has been finalized. It rarely says what amount was allowed, what the patient owes, why the claim was reduced, or what to do next, so someone picks up the phone. Integrex Health returns that detail with the status. Several payers share more of their adjudication data with us than a standard transaction carries.

Where the payer has already decided the claim, the answer comes back in the response and nobody makes the call. In the Orchestration Layer this is Recover and Report, with the appeal pathway carried from Authorize or Appeal.

An RCM firm serving a radiology and imaging group received a response on 7,204 of 7,500 status requests. Status calls fell by 90%.

Actual results vary based on volume, workflow design, denial mix, reimbursement and labor cost.