Claim Status Response Details
Claim Status Response DetailsThe details of an individual claim which satisfied the inquiry parameters are displayed on this page. It may be accessed directly from the Claim Status Activity Worklist or via the Claim Status Response page. The top portion of the page will contain the ID and the Last Name of the Client. The lower portion of the page, however is visually separated into Claim Level and Line Level sections.
The contents of this portion reflect the overall claim, not just this one line of the claim. All lines of a single claim will have identical data in this portion. You may receive up to 10 claim status responses for a single claim inquiry. Clicking the hyperlink of the Payer Claim ID will display the service line information for that Payer Claim ID. The first Payer Claim Id's service line information is initially displayed.
Payer Claim Control #: The payer assigned number used to uniquely identify each claim.
Total Claim Charge Amount: This value represents the total claim charge amount.
Paid Amount: This value represents the total claim payment amount. If the claim has not been finalized for payment or payment has not been authorized, this field will remain blank.
Dates of Service: This date range represents different data elements for different claim types. For Institutional claims, the date range represents the statement period. Similarly, for Professional claims, the range is the Claim From and Through Dates. However, Dental claims have a single Service Date and not a date range.
Status Effective Date: This date represents the effective date for the associated claim status.
Remittance Trace #: The corresponding Check or EFT Trace number.
Remittance Date: The date the remittance was generated.
Claim Level Status: Claim Status and Claim Status Category Codes and descriptions.
Bill Type: This value identifies the type of facility where services were performed.
Patient Control #: This value represents the unique number assigned to this visit. This may be referred to the Patient Account Number in the provider's billing system.
Pharmacy Control #: If a pharmacy control number was entered on the claim, it will display here.
Line: The number uniquely identifying a line on a claim.
Status: The codes and descriptions for the Claim Status and Claim Status Category codes.
Service Line Dates: The date(s) of service for that particular line.
Proc/NDC Code & Mod: The value(s) shown reflect the Procedure Code, National Drug Code and/or Modifiers (up to 4) for that specific line.
Line Charge Amount: The original dollar value submitted by the Provider for this line of the claim.
Paid Amount: If claim/line has been authorized for payment, the dollar value which has been paid by the payer.
Units: The original submitted units of service.
Status Date: This date represents the effective date for the associated line status.
Once you have reviewed the information displayed on the page, you have two options. You may click the Close button which will set the status of the response to "Viewed" or you may click Worked to mark the response as such, indicating that follow-up has been completed. Both buttons will close the details page and return you to the Claim Status Activity Worklist.
