Claim statuses
Every status a claim can have, what it means, and what action it enables.
Every claim carries one status at a time. The status determines what action is available — submit, amend, or nothing — and what the provider has or hasn't done with the claim.
The statuses
| Status | Meaning | Action available |
|---|---|---|
| Ready | Evaluated and prepared. Waiting for either automated submission to pick it up, or manual submission for programs that aren't auto-submitted. | Submit |
| Pending | Picked up by the program's submission processor — locked into the next batch and about to go out. Transient: most claims pass through Pending in seconds (per-event programs) or stay there until the cadence fires (cadenced programs like QLD Free Flu). | — |
| Submitted | Sent to the provider; awaiting their response. | — |
| Accepted | Approved by the provider. Claim is complete. | — |
| Rejected | Refused by the provider; error message shows why. | Amend |
| Failed | Something went wrong during processing. | Amend (if payload exists) |
| Ineligible | Light evaluated the claim and decided not to prepare it — the service didn't meet the program's rules. | Amend (if payload exists) |
| Removed | Manually abandoned. Won't be submitted and won't be re-evaluated. | — |
Transition rules
- Ready is the starting state for a successfully evaluated claim. For auto-submitted programs (most PPA programs once the site is enrolled, plus state programs like QLD Free Flu) the submission processor picks Ready claims up and moves them to Pending. For programs that aren't auto-submitted, a Ready claim stays Ready until you submit it manually.
- Pending is the staging state for the next submission batch. Per-event programs (NIPVIP, CVCP) move Pending → Submitted in seconds; cadenced programs (QLD Free Flu, NSW Free Intranasal) hold the batch until the program's submission day. While a claim is Pending you can still amend or remove it before it goes out.
- Submitted moves to Accepted or Rejected based on the provider's response.
- Rejected, Failed, and Ineligible can go back to Ready via amendment, provided the prepared payload is still available. After amendment, the cycle continues.
- Removed is terminal. Re-evaluating the encounter won't bring a Removed claim back — record a new encounter if the service was genuinely delivered.
AIR claims vs PPA / state claims
The two destinations behave differently:
- AIR encounter claims submit as soon as the underlying vaccination encounter is complete — they don't wait for the Ready / Pending / Submitted cadence in the same way, because the encounter itself is the trigger.
- PPA and state-funded claims (CVCP, NIPVIP, QLD Free Flu, NSW Free Intranasal, and others) follow Ready → Pending → Submitted. Whether Ready → Pending happens automatically depends on whether the site is enrolled in the program. See How claiming works and Enrolling in a program for the detail.
Status cards on the Claims page
Each status has a clickable summary card at the top of the Claims page. Tapping a card filters the table to claims in that status. Counts update in real time — useful for spotting a spike in rejections or a backlog of Ready claims.
Filtering by status
- Ready — your active to-do list; these claims need manual submission
- Rejected — claims that need investigation and amendment
- Failed — claims where something went wrong before the provider saw them; usually a data or connectivity issue
- Ineligible — claims that Light decided not to prepare, typically due to eligibility rules
- Removed — claims you abandoned manually; kept for audit but never submitted