Which causes a claim to be suspended?

Which causes a claim to be suspended?

• A. Services require additional info
• B. Provider license expired
• C. Insufficient patient balance
• D. Duplicate submission

Answer: (A)

A claim is suspended when the payer cannot process it due to missing or incomplete information, so it’s put on hold until the provider supplies what’s needed. When services require additional info, the system recognizes that key data—such as missing dates, documentation, or medical necessity details—are not present, and thus the claim is paused to await those items. Once the missing information is provided, the claim can be reprocessed and moved toward payment or denial. If the provider’s license has expired, the issue is credentialing/authentication rather than missing data for the claim, so it’s typically denied or blocked rather than suspended for information. An insufficient patient balance affects financial responsibility and collections, not the claim’s processing status. A duplicate submission triggers a duplicate check and is usually rejected or flagged, not put into suspension awaiting more information.

A claim is suspended when the payer cannot process it due to missing or incomplete information, so it’s put on hold until the provider supplies what’s needed. When services require additional info, the system recognizes that key data—such as missing dates, documentation, or medical necessity details—are not present, and thus the claim is paused to await those items. Once the missing information is provided, the claim can be reprocessed and moved toward payment or denial.

If the provider’s license has expired, the issue is credentialing/authentication rather than missing data for the claim, so it’s typically denied or blocked rather than suspended for information. An insufficient patient balance affects financial responsibility and collections, not the claim’s processing status. A duplicate submission triggers a duplicate check and is usually rejected or flagged, not put into suspension awaiting more information.