For the person who runs billing: what Pending means, why a row sits there, and what moves it.
The short version
Every code SaRA prepares starts as Pending. It becomes Ready to Bill when the patient has met the rule for that code and every earlier code for that patient has been marked Billed or Cancelled.
A Pending row is not billable yet. Do not bill it, and do not invoice anyone for it.
Some Pending rows never become billable. A patient who stopped responding stays Pending. That is expected, not an error.
Every Pending row tells you why. Open the Pending tab on the Billing page and hover the info icon on the row.
If you work from a spreadsheet export instead of the Billing page, the same rule applies: a row whose status reads BLK (blocked) is Pending. Only ELG (eligible) rows are ready.
The three kinds of codes
The full thresholds and payment figures live in RTM CPT codes and billing thresholds. Here is the part that matters for Pending.
Setup, 98975. Once per episode of care. SaRA only releases it when the same 30 day cycle also earns a monitoring code, so a setup code never bills for a patient who never responded.
Monitoring, 98977 or 98985 (98976 for respiratory). SaRA does not track 98984, 98978 or 98986. One per 30 day cycle. Responding on 2 to 15 days earns 98985. Responding on 16 or more days earns 98977. SaRA picks the code for you and switches it if the patient crosses 16 days.
Support, 98979, 98980 and 98981. One set per calendar month. The month needs at least one data review, at least one live interaction (a phone call, video call, or in person visit), and logged time: 10 minutes for 98979, 20 minutes for 98980, and 98981 for each extra 20 minutes.
The reasons you will see, and what moves each one
Hover the info icon on any Pending row and SaRA spells out the reason in a sentence, with the date it becomes ready when there is one.
Reason on the row | What it means | What releases it |
Awaiting Cycle End | The patient's 30 day cycle is still running. | Nothing to do. It releases the day after the cycle ends. |
Monthly Reset | Support codes cover a calendar month, so they are only ready once the month is over. | Nothing to do. It releases on the 1st. |
Connect Requires Engage | The setup code (98975) is waiting for the same cycle to earn a monitoring code. | The patient responding on 2 or more days. Then both codes release together. If the patient never does, this row stays Pending. |
30 Days Rule | A monitoring code for this patient was marked Billed less than 30 days before this one's date. Payers deny the second one. | Nothing to do. It releases on the date shown on the row. |
Prior Billing Pending | An earlier code for this patient is Ready to Bill, but nobody has marked it Billed or Cancelled. | You. Find the earlier row in Ready to Bill and mark it Billed (or Cancel it with a reason). This row releases right away. |
Prior Billing Blocked | The earlier code for this patient is itself Pending. | Fix the earlier row first. Its own reason tells you what it is waiting on. |
Mark it Billed, or the chain stops
Codes for one patient form a chain. Marking a row Billed tells SaRA the code went out, and it releases the next code for that patient. If you bill in your own system but never mark the row Billed in SaRA, the next cycle sits in Pending with Prior Billing Pending, and every cycle after it stacks up behind it.
A code that should not go out gets Cancelled with a reason. Cancelling releases the chain the same way.
If a patient's newer codes keep showing Pending, look for an older Ready to Bill row for the same patient first. One forgotten row from months ago is the usual cause.
Why a row from months ago can appear in Ready to Bill today
A released row keeps its original dates. If a patient's code from June was held behind an earlier cycle, it stays in Pending until that earlier code is marked Billed or Cancelled, and then it moves to Ready to Bill dated June. Nothing was added late; the row was there the whole time, in the Pending tab.
This matters when your payers have a short filing window. Workers' compensation plans commonly allow 60 days from the date of service, so a released row that is older than that may be denied for timely filing. If SaRA bills for you, our billing team submits what the window still allows and works the denials on the rest. If you self-bill, work the Pending tab weekly so older cycles are released while they can still be filed.
Providers who only sign will see these older rows in their sign-off list. That is expected: signing releases the claim. It does not change the date of service.
If you invoice other clinics from SaRA's data
Groups that bill on behalf of several clinics should invoice from what became Ready to Bill, or from what was marked Billed, in the month. Never from Pending.
The date a code became ready is the date that matters, not the cycle date. A row that was Pending in July and became ready in September belongs to September's invoice.
On the Billing page, pick the clinic in the selector at the top and the month filter. The list and the PDF download follow your selection, so you can work one clinic at a time.
Quick answers
Will a Pending row turn ready on its own?
For Awaiting Cycle End, Monthly Reset and 30 Days Rule, yes. For Connect Requires Engage, only if the patient responds. For Prior Billing Pending, only when you mark the earlier row.
A row I already billed is still in Ready to Bill.
It was billed in your system but not marked Billed in SaRA. Mark it now so the patient's next code can release.
A row shows no reason at all.
Message us from the chat bubble in SaRA or email [email protected] with a screenshot of the row and we will sort it with you.