Certified Medical Administrative Assistants (CMAA) Practice Exam

What term describes a claim that is held by an insurance company pending additional information?

1. Denied claim

2. Awaiting claim

3. Pending claim

4. Suspended claim

The correct answer is: Pending claim

The term that accurately describes a claim that is held by an insurance company pending additional information is a "pending claim." This nomenclature indicates that the insurer is in a state of awaiting further details or documentation before they can finalize their assessment and make a payment decision. In the context of insurance claims processing, a pending claim typically means that the insurer recognizes the claim but requires more information or verification, which can vary from missing medical records to additional medical evaluation results. This status is important because it signals to the healthcare provider and the patient that the claim is still under consideration, rather than being outright denied or resolved. Understanding this terminology is vital for anyone involved in medical administration, as it facilitates effective communication between providers and insurance companies regarding the status of claims, ensuring that billing can be managed efficiently.