Understand Provider Status

A provider may be at any of the following statuses:

  • Wizard Incomplete: You have not finished enrolling the provider. A provider is set to this status when you click Close For Now during the enrollment process. You can have up to nine (9) providers in this status at a time.
  • Pending: You have finished enrolling the provider, but you did not provide any licensing information for them. Any claim you receive from providers at this status is automatically disallowed.
  • Active: The provider is ready to process claims.
  • Hold: The provider is active and can submit claims, but those claims are put on hold and are not submitted to the state.
  • Removed: You have removed the provider from your system and they are no longer active.

How Provider Status Affects Claims Processing

The status of your providers affects whether or not you can process claims for them. The table below provides a guide for how provider status can affect claims processing.

StatusCan you process claims for them?
Wizard IncompleteNo
PendingYes - But may be disallowed.
HoldYes - But, claims are automatically placed on hold.
RemovedYes - But, any dates after the removal date will be disallowed.*

*Example: A provider leaves your sponsorship on 8/20, but has submitted an August claim for 8/1 - 8/19. You remove them from your system on 8/20. When you process August claims in September, this provider's claim is not automatically disallowed (unless an edit check flags different issues), since the claim precedes their removal date.