This article explains the statuses a claim moves through in MedMe, from the moment it is saved to the payer's final response, and which actions pharmacy teams can take at each stage.
Table of Contents
Overview
Every claim shows a status chip wherever it appears: on the Claims page, the patient's Billing tab, the appointment's Claims card, and the Claim Details modal. The status tells you whether the claim is still in the pharmacy's hands, on its way to the payer, or adjudicated.
Claim Status Reference
Status | Meaning | Who acts next |
Draft | The claim has been saved but not submitted. Required fields may be empty. | Pharmacy — edit and submit, or delete |
Ready for Submission | Submit for Billing was selected. The claim is queued and will be sent to the clearinghouse overnight. It can still be undone. | Pharmacy — undo within 24 hours if needed |
Submitted | The claim has been sent to the clearinghouse. It can no longer be edited or undone. | Clearinghouse / payer |
Accepted | The clearinghouse or payer acknowledged the claim and it is moving to adjudication. | Payer |
Rejected | The clearinghouse or payer rejected the claim before adjudication, usually for missing or mismatched information. The reason is shown on the claim. | Pharmacy — edit and resubmit |
Paid | The payer adjudicated the claim and paid the full allowed amount. Final. | None |
Partially Paid | The payer paid some lines or amounts and adjusted or denied others. Details are on the Remittances tab. | Pharmacy — review; edit and resubmit if warranted |
Denied | The payer adjudicated the claim and denied payment. Reason codes are on the Remittances tab. | Pharmacy — edit and resubmit, or bill another way |
Resubmitted | A corrected version of the claim has been sent to the clearinghouse after a rejection, denial, or partial payment. Tracked on the same claim number. | Clearinghouse / payer |
Cancelled | The pharmacy withdrew the claim. Final; create a new claim to bill the services again. | None |
The Claim Lifecycle
Draft → the pharmacist selects Submit for Billing → Ready for Submission.
Overnight, MedMe sends queued claims to the clearinghouse → Submitted (or Resubmitted for a corrected claim). The Submitted On date and Submitted By user are recorded.
The clearinghouse and payer acknowledge the claim → Accepted, or reject it → Rejected.
The payer adjudicates and sends a remittance (ERA) → Paid, Partially Paid, or Denied.
After a rejection, denial, or partial payment the pharmacist can Edit and Resubmit, which returns the claim to Ready for Submission and then Resubmitted.
Reminder: Ready for Submission is the last point where a claim can be pulled back without contacting the payer. Once it is Submitted, the only option is to wait for the payer's response. An Accepted claim can be cancelled.
Actions Available by Status
Open the ⋯ menu on any claim row to see its actions. View Details is available for every status except Draft; selecting a draft opens it in the Edit Claim modal instead.
Status | Edit | Delete Draft Claim | Undo Submission | Cancel Claim |
Draft | Yes — then Save as Draft or Submit for Billing | Yes | — | — |
Ready for Submission | — | — | Yes | — |
Submitted | — | — | — | — |
Accepted | — | — | — | Yes |
Resubmitted | — | — | — | — |
Rejected | Yes — then Resubmit | — | — | — |
Denied | Yes — then Resubmit | — | — | — |
Partially Paid | Yes — then Resubmit | — | — | — |
Paid | — | — | — | — |
Cancelled | — | — | — | — |
The same menu is available on the Claims page, the patient's Billing tab, and the appointment's Claims card.
Deleting a Draft Claim
A draft that is no longer needed can be deleted. Only Draft claims can be deleted.
Open the claim's ⋯ menu and select Delete Draft Claim.
The confirmation explains that the draft and everything entered on it will be permanently deleted. Select Delete Draft Claim to confirm or Keep Draft to go back.
The message Draft claim deleted. appears and the claim is removed from every claims list.
Warning: Deleting a draft cannot be undone. If the claim might still be needed, keep it as a draft instead.
Undoing a Submission
A claim in Ready for Submission can be pulled back for 24 hours, until it is sent overnight.
Select Undo on the confirmation message shown right after submitting, or open the claim's ⋯ menu and select Undo Submission.
The claim returns to Draft (a first submission) or to its previous status of Rejected, Denied, or Partially Paid (a resubmission), and the message Claim moved to Draft confirms it.
Select Edit to correct the claim and submit again.
Cancelling a Claim
Cancelling withdraws an Accepted claim from the payer. Claims that are Submitted or Resubmitted cannot be cancelled until the payer accepts them.
Open the claim's ⋯ menu and select Cancel Claim.
The confirmation names the payer and explains that the claim will no longer be processed. Select Cancel Claim to confirm or Keep Claim to go back.
The cancellation lifecycle
A cancellation is sent to the payer in the same way as a claim, so it moves through its own statuses:
Cancellation Submitted — the cancellation has been sent to the clearinghouse.
Cancellation Accepted — the payer received the cancellation and is processing it. If the payer refuses it, the status is Cancellation Rejected instead.
The payer finishes processing the cancellation:
Cancelled — the claim had not been paid, so it is closed with no payment.
Reversed — the claim had already been paid, so the payer takes the payment back.
If a cancellation is Cancellation Rejected, the original claim is still active with the payer. It can be corrected and resubmitted, or the cancellation can be sent again.
Warning: Cancelling cannot be undone, and a Cancelled or Reversed claim cannot be edited or resubmitted. To bill the services again, create a new claim for the same appointment. Claims that have already been adjudicated (Paid, Partially Paid, Denied) cannot be cancelled.
Troubleshooting
The claim has been Ready for Submission for more than a day. Claims are sent overnight. If the status has not changed to Submitted by the next business morning, contact the MedMe RCM team.
I cannot edit a Submitted claim. Wait for the payer's response. Once the claim is Accepted it can be cancelled, and a new claim can be created.
I created a draft by mistake. Select Delete Draft Claim from the claim's ⋯ menu.
A claim shows Rejected. Open it to read the reason, then Edit and Resubmit. See How to Fix and Resubmit a Rejected or Denied Claim in MedMe.
Total Paid shows a dash. No remittance has been received yet. Paid amounts appear when the payer's ERA arrives.
Conclusion
A claim starts as a Draft, becomes Ready for Submission when submitted, is Submitted to the clearinghouse overnight, and ends as Paid, Partially Paid, or Denied after adjudication. Pharmacy teams can edit or delete drafts, undo queued submissions within 24 hours, cancel accepted claims, and edit and resubmit rejected or denied ones.
See more:
If additional assistance is needed, contact the MedMe RCM team.