Claim Status Inquiry: How to Track Claims from Submission to Payment
A claim status inquiry is a request to a payer that asks where a submitted claim stands. It can be a portal lookup, a phone call, or the electronic 276/277 transaction pair. This guide shows therapists, psychiatrists, and billing staff how to read the answers and build a follow-up routine that catches problems early.
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What a claim status inquiry is and why it matters
Sending a claim is not the same as getting paid.
After you submit a claim, three things can happen. The payer can reject it, deny it, or accept it and pay. Until you check, you do not know which. A claim status inquiry closes that gap. It tells you whether the payer received the claim, whether it is still being worked, and what the next step is.
Many practices only run a claim status inquiry when the money is late. That is slow. A claim rejected for a missing field on day one will sit for weeks if nobody asks. A regular claim status inquiry catches those claims while they are still easy to fix.
This matters for both psychotherapists and psychiatrists. A therapist may send a high volume of low-dollar claims. A psychiatrist may send fewer claims with higher-paid evaluation and management (E/M) codes. In both cases, a claim status inquiry is how you find stuck claims before timely filing limits close. MCM South runs claim status work every week for psychotherapists and psychiatrists, and the routine below is one any office can copy.
For definitions of the terms in this guide, keep our claims processing glossary open in another tab.
How a claim status inquiry works: 276, 277, and 277CA
Electronic claim status runs on two transaction pairs and one acknowledgment.
The 276 is the request your system sends. The 277 is the payer's reply. The standards group X12 lists them as the Health Care Claim Status Request and Response (X12 transaction sets, checked 10/10/26). The Centers for Medicare & Medicaid Services (CMS) lists ASC X12N 276/277 Version 5010 as the adopted standard under the Health Insurance Portability and Accountability Act (HIPAA). It also lists federally mandated operating rules for claim status, with a standard compliance date of January 1, 2012 and an operating rule date of January 1, 2013 (CMS adopted standards and operating rules, checked 10/10/26).
The operating rules come from CAQH CORE, the group HHS designated to write them. Its Claim Status rule set standardizes how a provider asks for status and how a plan answers (CAQH CORE operating rules, checked 10/10/26). Your clearinghouse or practice management system sends the 276 and reads the 277 for you.
The 277CA is a different thing
The 277CA, or claim acknowledgment, is the report you get soon after you submit a claim. It is a 5010A1 response that reports the status of submitted claims. Its status segment carries a claim status category code, a claim status code, and sometimes an entity identifier. The category code gives the general result, such as accepted, rejected, or more information needed (CGS 277CA user guide, checked 10/10/26).
Think of the 277CA as the front desk receipt, and the 276/277 claim status inquiry as the check-in call. The first tells you the claim was accepted or bounced at the door. The second tells you where an accepted claim is now.
The CGS guide shows one example. A category code of A7 marks a rejection for invalid information, and the claim status code gives the cause. You fix the claim file and resubmit. That same guide is from one Medicare administrative contractor, so your clearinghouse may show codes in its own wording.
Rejected, denied, or pending: reading a claim status inquiry
These three words mean different things and need different actions.
| Status | What it usually means | What you do |
|---|---|---|
| Rejected | The claim failed front-end checks and was not processed for payment | Fix the error named on the report and resubmit as a new claim |
| Denied | The payer processed the claim and refused payment | Read the reason codes, then correct and resubmit or appeal |
| Pending | The payer has the claim and is still working it | Note the date, set a follow-up date, and check again |
| Paid | The payer processed and paid all or part | Post the payment, then check for a secondary payer |
These are common industry meanings. Payers use their own wording, so read the response text itself. A rejected claim often never gets a remittance, while a denied claim shows up on the electronic remittance advice. Our electronic remittance advice guide explains how to read the denial codes on that file.
If you do not know the term a payer used, look it up in our claim denial terms glossary. A denial is a process, not a dead end. The next step is usually a corrected claim or an appeal, covered in our claim denials and appeals pages.
Six steps for a claim status inquiry routine
Repeat the same six steps for every claim batch.
- Check the acknowledgment first. Review the 277CA or the clearinghouse report for every batch. Fix rejections the same day.
- List claims that have no payer response. Sort your open claims by date submitted and flag any with no acknowledgment or no remittance.
- Run the claim status inquiry. Use the payer portal or your clearinghouse to send a 276. Use the claim number, patient ID, date of service, and billed amount.
- Write down the answer. Record the status, the payer's reference number, and the date. If you phone, add the name of the representative.
- Act on the status. Resubmit rejections, correct or appeal denials, and set a follow-up date for pending claims.
- Review the list weekly. Look for patterns: one payer, one code, or one missing field. Fix the cause upstream, and track days in accounts receivable as part of your practice management numbers.
Set the follow-up interval from your payer contracts and your own history. We do not give a single number of days, because payers differ and because timely filing limits are set by each payer. Ask each payer for its limit and add it to your tracking sheet. Also check each payer's own rules for how often you may send the same claim status inquiry.
How do I do a claim status inquiry for a mental health claim?
Here is the short version.
Short answer: Check the 277CA first to confirm the payer accepted the claim. Then send a claim status inquiry through the payer portal or your clearinghouse, using the claim number, patient ID, date of service, and billed amount. Record the answer and act on it: fix rejections, appeal denials, and set a follow-up date for pending claims.
The process is the same for psychotherapy and psychiatric E/M claims. What changes is the codes you review: check that the E/M code and any add-on psychotherapy code appear on the claim as billed. Our CMS-1500 guide shows where each piece of data goes.
Claim status inquiry by payer type: private, Medicare, and Medicaid
Keep the three types of payer separate.
Private plans
Private plans may offer a portal, an electronic 276/277, or a phone line. Capabilities differ by plan. Some give line-level detail and some give only claim-level status. Keep a payer sheet that notes which method each plan supports. Our private insurance guides list how to reach the major plans.
Medicare
Medicare is served by Medicare administrative contractors (MACs), and each publishes its own EDI instructions and tools. The CGS guide above is one example of a contractor's 277CA instructions. Use your own contractor's guide, not another region's.
Medicaid and state programs
Medicaid is run by each state, and many members are in managed care plans. Status tools and rules differ by state and by plan. Use the state Medicaid agency's billing manual and the plan's portal. Never copy one state's process into another.
What to do Monday morning
Make the first week light and repeatable.
- Export a list of all claims with no payment posted, sorted by date of service.
- Check the clearinghouse for rejected claims and fix the oldest first.
- Send a claim status inquiry on the five oldest pending claims and record the answers.
- Write each payer's timely filing limit and preferred status method on one tracking sheet.
- Read the practices we serve page, then browse our billing resources for the next topic on your list.
Frequently asked questions
What is a claim status inquiry?
A claim status inquiry is a request to a payer that asks where a submitted claim stands. It can be sent as an electronic 276 transaction, through a payer portal, or by phone. The reply tells you if the claim is pending, paid, denied, or rejected.
What is the difference between a 276/277 and a 277CA?
The 276/277 pair is a claim status inquiry and its response. The 277CA is an acknowledgment sent after submission that reports whether the claim was accepted or rejected at intake, with codes that name the problem.
What is the difference between a rejected and a denied claim?
A rejected claim usually failed front-end checks and was not processed for payment, so you fix it and resubmit. A denied claim was processed and refused, so you review the reason codes, then correct or appeal.
How often should I send a claim status inquiry?
Set the schedule from your payer contracts and your own history. Check acknowledgments for every batch, then run a claim status inquiry on any claim with no response. Ask each payer for its timely filing limit.
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Checked 10/10/26: CMS: Adopted Standards and Operating Rules; CAQH CORE: Operating Rules; X12: Transaction sets; CGS Medicare: 277CA EDI Edit User Guide.