Claim lifecycle
A complete thread, without a false finish line.
A claim can be transmitted without being accepted, accepted without being paid, and posted without cash being reconciled. Each step needs its own evidence.
Follow the evidence.
Authorized intake/Coverage review/Claim draft/Required approvals/Send attempt/Acknowledgments/Adjudication/Remittance/Posting/Cash reconciliation
| Stage | Evidence to keep | When work stops |
|---|---|---|
| Intake | Source batch, mapping and encounter version | Missing or conflicting facts |
| Preparation | Supported codes, edits and review decisions | Evidence or mandatory review missing |
| Submission | Exact claim version and transmission attempt | Authorization or integration unavailable |
| Acknowledgment | 999 / 277CA response lineage | Rejected or uncertain transmission |
| Follow-up | Status/denial evidence and approved next action | Unverified deadline or unsupported appeal |
| Reconciliation | 835, posting basis and separate cash record | Unmatched, stale or ambiguous financial evidence |
Exceptions re-enter with a history.
Correcting a rejected claim, revising coding or responding to a denial creates traceable work. It does not erase the earlier version, approval or attempt.