Claim Statuses

It is up to the Agency to check in on Claims and their statuses. This can easily be viewed in Financials > Claims Management by clicking on the Claims card.

The following statuses are applied to claims:

• In Transit: When a claim is initially sent, it will display as In Transit. This status shouldn’t last more than 15 minutes.

• Sent: Once the claim has been sent to the Payor, its status changes from In Transit to Sent. The next update can take anywhere from 30 minutes to 3 hours.

• Send Failed: Pavillio is unable to connect to transmit the file. For agencies using Direct Connect, this means that the user's password has expired and needs to be updated. For others, there is an issue on the payor's end. As a first step, resend the claim. If unable to resolve, contact support.

• Accepted: The batch was received by the Payor/Clearing House and accepted.

• Rejected: There was an issue with the batch and the Payor/Clearing House could not accept the file. These need to be checked and re-worked by the agency and resent.

• Status Requested: Pavillio has sent a request for claim status.

• Pending:This status comes back from the Payor after a status is requested. The Agency needs to check with the Payor or in the MCO portal for more information.

• Will Pay: The Payor has indicated that the claim is fully paid.

• Will Deny:The Payor has indicated that the claim is denied.

• Will Partially Pay: The Payor has indicated that the claim is partially paid.

Once the claim is accepted, the claim statuses that follow depend on the Payor, meaning there is no standard timeline for them. MN DHS claims update quickly, and the MCOs vary. As a general rule, anything in Sent status longer one week should be checked. Create a Support Request for assistance.