Checking the Status of Your Medical Billing Claims

Accessing the Medical Billing Screen

To view the status of submitted claims, navigate to the Medical Billing Status Screen:

Go to Service History
Select Medical Billing

Overview of the Medical Billing Screen

The Medical Billing screen provides an overview of all submitted medical billing transactions. It displays the claim's status and allows visibility to medical claims submitted for up to 365 days in the past.

All medical billing transactions are recorded on the screen the next day after submission in the PMS.
If your claim was generated from a clinical workflow in the Outcomes platform, this may take up to 3 to 4 days to be visible.
Outcomes handles all aspects of claims submission, processing and follow-up. There is no action needed on your part.

Information on the Medical Billing Status Screen Includes:

Field	Description
Claim ID	Unique identifying number for the submitted claim.
Name	Patient's name associated with the vaccine administration and submitted claim.
Administered	Date of vaccine administration and the corresponding claim’s date of service.
Vaccination	Type of vaccine administered, grouped by disease state.
Rx Number	PMS-generated Rx number identifying the patient and prescription.
Plan Name	Name of the patient’s insurance received from the PMS.
Member ID	Patient’s insurance member ID number.
HCPCS Code	Healthcare Common Procedure Coding System code for vaccine administration.
CPT Code	Current Procedural Terminology code billed for the vaccine product.
Claim Status	Reflects the current stage of the claim within the billing process. See Claim Status Definitions section for more information.
Billed Amount	Total amount billed to the payer for the claim.
Paid Amount	Amount reimbursed by the insurance provider.
Adjustment Amount	Any adjustments applied to the claim after processing, including contractual changes or non-reimbursable claim denials.

Claim Status Definitions

Status	Description
New	The initial status applied when a vaccine medical billing encounter is received. This confirms that the pharmacy's submission was received by Outcomes, but the claim has not yet been billed.
Accepted	Indicates that the claim has been successfully entered into the billing process within Outcomes. At this stage, the claim is being prepared for submission to the payer.
Processing	The claim is under review with the payer. During this phase, the patient's insurance provider evaluates the submission for accuracy, eligibility, and reimbursement.
Adjudicated	The claim has completed processing with the payer. The claim may be paid, adjusted, or written off based on the payer's determination. Reference the claim value fields in the Medical Billing screen to see how the claim was finalized.

Frequently Asked Questions (FAQs)

1. How do I access the Medical Billing Status screen?

To access the Medical Billing Status screen, navigate to Service History and select Medical Billing. This screen displays all submitted medical billing transactions.

2. How far back can I view medical billing claims?

You can view medical billing transactions submitted within the past 365 days on the Medical Billing screen.

3. When will my claim appear on the Medical Billing screen?

Most claims appear on the Medical Billing screen the next day after submission through the PMS. If a claim was generated from a clinical workflow in the Outcomes platform, it may take 3 to 4 days to be visible.

4. Do I need to take any action to submit or manage claims?

No. Outcomes manages all aspects of medical claim submission, processing, and follow‑up. No action is required from the pharmacy once a claim has been submitted through the workflow.

5. What does the Claim Status mean?

The Claim Status reflects where the claim is in the billing lifecycle:

- New: Submission received by Outcomes but not yet billed
- Accepted: Entered into the billing process and preparing for payer submission
- Processing: Under review by the payer
- Adjudicated: Finalized by the payer and may be paid, adjusted, or written off

6. Why does a claim show an adjustment amount?

The Adjustment Amount reflects changes made during payer processing, such as contractual adjustments or denied, non‑reimbursable portions of the claim.

7. What should I do if a claim shows as adjudicated with no payment?

An adjudicated claim does not always result in payment. Review the Paid Amount and Adjustment Amount fields for details. Outcomes handles payer follow‑up when needed.

8. Can I edit or resubmit a claim from the Medical Billing screen?

No. The Medical Billing Status screen is view‑only. Claims cannot be edited or resubmitted by the pharmacy once submitted.

9. Can I filter or search for a specific claim?

The Medical Billing screen allows you to review submitted claims within the past 365 days. Each column can be sorted, and you can filter by claim status.

10. What is the difference between Billed Amount and Paid Amount?

Billed Amount represents the total amount submitted to the payer.
Paid Amount reflects what the payer reimbursed after adjudication.

Any difference between the two is reflected in the Adjustment Amount.

11. Why does a claim show as Processing for an extended period?

Claims remain in Processing while they are under review by the payer. Processing timelines vary by insurance carrier and do not indicate an issue with the claim.

12. Will denied claims appear differently?

Denied claims are still reflected as Adjudicated. Review the Paid Amount and Adjustment Amount fields to understand the outcome.

13. Can I export or download claim data from this screen?

Yes. you can select all claims or specific claims for export. Choose the checkbox on the left side of the claim record for specific claims or choose the checkbox next to Claim ID in the header row for all records. This will enable an Export button on the screen. Clicking Export will download a .csv file.

14. Who should I contact with questions about a specific claim?

If you have questions about a claim after reviewing the information on the Medical Billing screen, contact the Outcomes support team through your standard support channels.

15. I am subscribed to Medical Billing but do not see the Medical Billing Status screen. Why?

If you are subscribed to Medical Billing but do not see the Medical Billing Status screen, you may need to complete a one‑time account linking process. This step is required to connect your pharmacy account to medical billing visibility.

16. I have completed account linking and still do not see the screen. What should I do?

If you have already completed account linking and still do not see the Medical Billing Status screen:

- Confirm that you have the appropriate user permissions by contacting your Pharmacy Administrator

If the issue persists, please contact Outcomes Customer Support for assistance.