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CLAIM STATUS CATEGORY SEARCH:

 
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Code : A0
Description : Acknowledgement/Forwarded-The claim/encounter has been forwarded to another entity.
Dates : Start: 01/01/1995
Code : A1
Description : Acknowledgement/Receipt-The claim/encounter has been received. This does not mean that the claim has been accepted for adjudication.
Dates : Start: 01/01/1995
Code : A2
Description : Acknowledgement/Acceptance into adjudication system-The claim/encounter has been accepted into the adjudication system.
Dates : Start: 01/01/1995
Code : A3
Description : Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system.
Dates : Start: 01/01/1995
Code : A4
Description : Acknowledgement/Not Found-The claim/encounter can not be found in the adjudication system.
Dates : Start: 01/01/1995
Code : A5
Description : Acknowledgement/Split Claim-The claim/encounter has been split upon acceptance into the adjudication system.
Dates : Start: 02/28/2002
Code : A6
Description : Acknowledgement/Rejected for Missing Information - The claim/encounter is missing the information specified in the Status details and has been rejected.
Dates : Start: 10/31/2002
Code : A7
Description : Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected.
Dates : Start: 10/31/2002
Code : A8
Description : Acknowledgement / Rejected for relational field in error.
Dates : Start: 10/31/2004
Code : P0
Description : Pending: Adjudication/Details-This is a generic message about a pended claim. A pended claim is one for which no remittance advice has been issued, or only part of the claim has been paid.
Dates : Start: 01/01/1995
Code : P1
Description : Pending/In Process-The claim or encounter is in the adjudication system.
Dates : Start: 01/01/1995
Code : P2
Description : Pending/Payer Review-The claim/encounter is suspended and is pending review (e.g. medical review, repricing, Third Party Administrator processing).
Dates : Start: 01/01/1995 | Last Modified: 01/27/2008
Code : P3
Description : Pending/Provider Requested Information - The claim or encounter is waiting for information that has already been requested from the provider. (Note: A Claim Status Code identifying the type of information requested, must be reported)
Dates : Start: 01/01/1995 | Last Modified: 01/27/2008
Code : P4
Description : Pending/Patient Requested Information - The claim or encounter is waiting for information that has already been requested from the patient. (Note: A status code identifying the type of information requested must be sent)
Dates : Start: 01/01/1995 | Last Modified: 01/27/2008
Code : P5
Description : Pending/Payer Administrative/System hold
Dates : Start: 10/31/2006
Code : F0
Description : Finalized-The claim/encounter has completed the adjudication cycle and no more action will be taken.
Dates : Start: 01/01/1995
Code : F1
Description : Finalized/Payment-The claim/line has been paid.
Dates : Start: 01/01/1995
Code : F2
Description : Finalized/Denial-The claim/line has been denied.
Dates : Start: 01/01/1995
Code : F3
Description : Finalized/Revised - Adjudication information has been changed
Dates : Start: 02/28/2001
Code : F3F
Description : Finalized/Forwarded-The claim/encounter processing has been completed. Any applicable payment has been made and the claim/encounter has been forwarded to a subsequent entity as identified on the original claim or in this payer's records.
Dates : Start: 01/01/1995
Code : F3N
Description : Finalized/Not Forwarded-The claim/encounter processing has been completed. Any applicable payment has been made. The claim/encounter has NOT been forwarded to any subsequent entity identified on the original claim.
Dates : Start: 01/01/1995
Code : F4
Description : Finalized/Adjudication Complete - No payment forthcoming-The claim/encounter has been adjudicated and no further payment is forthcoming.
Dates : Start: 01/01/1995
Code : F5
Description : Finalized/Cannot Process
Dates : Start: 01/01/1995 | Stop: 10/16/2003
Code : R0
Description : Requests for additional Information/General Requests-Requests that don't fall into other R-type categories.
Dates : Start: 01/01/1995
Code : R1
Description : Requests for additional Information/Entity Requests-Requests for information about specific entities (subscribers, patients, various providers).
Dates : Start: 01/01/1995
Code : R3
Description : Requests for additional Information/Claim/Line-Requests for information that could normally be submitted on a claim.
Dates : Start: 01/01/1995 | Last Modified: 02/28/1998
Code : R4
Description : Requests for additional Information/Documentation-Requests for additional supporting documentation. Examples: certification, x-ray, notes.
Dates : Start: 01/01/1995 | Last Modified: 02/28/1998
Code : R5
Description : Request for additional information/more specific detail-Additional information as a follow up to a previous request is needed. The original information was received but is inadequate. More specific/detailed information is requested.
Dates : Start: 01/01/1995 | Last Modified: 06/30/1998
Code : R6
Description : Requests for additional information - Regulatory requirements
Dates : Start: 02/28/2007
Code : R7
Description : Requests for additional information - Confirm care is consistent with Health Plan policy coverage
Dates : Start: 02/28/2007
Code : R8
Description : Requests for additional information - Confirm care is consistent with health plan coverage exceptions
Dates : Start: 02/28/2007
Code : R9
Description : Requests for additional information - Determination of medical necessity
Dates : Start: 02/28/2007
Code : R10
Description : Requests for additional information - Support a filed grievance or appeal
Dates : Start: 02/28/2007
Code : R11
Description : Requests for additional information - Pre-payment review of claims
Dates : Start: 02/28/2007
Code : R12
Description : Requests for additional information - Clarification or justification of use for specified procedure code
Dates : Start: 02/28/2007
Code : R13
Description : Requests for additional information - Original documents submitted are not readable. Used only for subsequent request(s).
Dates : Start: 02/28/2007
Code : R14
Description : Requests for additional information - Original documents received are not what was requested. Used only for subsequent request(s).
Dates : Start: 02/28/2007
Code : R15
Description : Requests for additional information - Workers Compensation coverage determination.
Dates : Start: 02/28/2007
Code : R16
Description : Requests for additional information - Eligibility determination
Dates : Start: 02/28/2007
Code : RQ
Description : General Questions (Yes/No Responses)-Questions that may be answered by a simple 'yes' or 'no'.
Dates : Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
Code : E0
Description : Error: Response not possible - error on submitted request data
Dates : Start: 01/01/1995 | Last Modified: 02/28/2002
Code : E1
Description : Error: Response not possible - System Status
Dates : Start: 02/29/2000
Code : E2
Description : Error: Information Holder is not responding; resubmit at a later time.
Dates : Start: 06/30/2003
Code : E3
Description : Error: Correction required - relational fields in error.
Dates : Start: 01/24/2010
Code : E4
Description : Error: Trading partner agreement specific requirement not met: Data correction required. (Note: A status code identifying the type of information requested must be sent)
Dates : Start: 01/30/2011
Code : D0
Description : Error: Data Search Unsuccessful - The payer is unable to return status on the requested claim(s) based on the submitted search criteria.
Dates : Start: 01/01/1995 | Last Modified: 09/20/2009


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