Quick answer: A claim's status appears as a colored chip showing where it is — from Draft and Hold through Pending, Error, Rejected, and payer outcomes like Approved or Paid. Error claims can be retried in Barti; Rejected claims are fixed in TriZetto.
Who this is for: Billing and claims staff submitting claims through TriZetto.
Claim statuses
A claim's status appears as a colored chip on the claim and in the claims list. The statuses below are listed roughly in the order a claim moves through.
Working statuses
- DRAFT: The claim is still being built or scrubbed. It's editable.
- HOLD: The claim is validated and ready to submit (Hold = Ready). It's editable.
- PENDING: The claim has been submitted to the clearinghouse and is awaiting a response.
- NEEDS_INFO: The clearinghouse or payer needs more information before the claim can be processed.
- ERROR: The claim failed to submit to the clearinghouse — usually a connection issue with TriZetto or a problem with your username and password. First use Retry Submission to move it back to Hold and resubmit; if it errors again, re-save your TriZetto username and password in Barti and retry once more — see How do I retry a claim that failed to submit?
- REJECTED: The clearinghouse or payer declined the claim. You must fix the rejection in TriZetto.
Payer outcome statuses
These are set from the payer's response after the claim is processed:
- APPROVED: The payer approved the claim.
- PARTIAL: The claim was partially approved/adjudicated.
- PARTIAL_PAID: The claim was partially paid.
- PAID: The claim was paid in full.
- REVERSED_PAYMENT: A previously recorded payment was reversed.
Common rejection reasons
- General Rejections ("Invalid Information"): No specific detail is provided — reach out to TriZetto for the exact issue.
- "Insured/Subscriber – Invalid Information": The member ID is wrong or the policy is inactive. Check and update the member ID before resubmitting.
- "Provider Not Approved": The provider isn't approved to send electronic claims to that payer. Contact customer service for enrollment.
Troubleshooting
How do I fix a rejected claim?
Corrections for rejected claims are made in TriZetto. After fixing, you can mark the claim as resubmitted in Barti so its status updates.
What's the difference between Error and Rejected?
Error means the claim failed to transmit and can be retried in Barti. Rejected means it reached the clearinghouse or payer and was declined — fix it in TriZetto.
My claim is stuck in Pending — what does that mean?
Pending means the claim has been submitted and is awaiting a clearinghouse response.