Claim Status Category Codes

Claim Status Category codes are used in the Health Care Claim Status Notification (277) transaction. They indicate the general category of the status (accepted, rejected, additional information requested, etc.) which is then further detailed in the Claim Status Codes. Claim status codes communicate information about the status of a claim. The Claim Status transaction is not used as a financial transaction.

Code	Description
	Supplemental
X0	Supplemental Messages
	Acknowledgements
A0	Acknowledgement/Forwarded-The claim/encounter has been forwarded to another entity.
A1	Acknowledgement/Receipt-The claim/encounter has been received. This does not mean that the claim has been accepted for adjudication.
A2	Acknowledgement/Acceptance into adjudication system-The claim/encounter has been accepted into the adjudication system.
A3	Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system.
A4	Acknowledgement/Not Found-The claim/encounter can not be found in the adjudication system.
A5	Acknowledgement/Split Claim-The claim/encounter has been split upon acceptance into the adjudication system.
A6	Acknowledgement/Rejected for Missing Information- The claim/encounter is missing the information specified in the Status Details and has been rejected.
A7	Acknowledgement/Rejected for Invalid Information- The claim/encounter has invalid information as specified in the Status Details and has been rejected.
A8	Acknowledgement/Rejected for relational field in error.
	Pending
P0	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.
P1	Pending/In Process-The claim or encounter is in the adjudication system.
P2	Pending/In Review-The claim/encounter is suspended pending review.
P3	Pending/Requested Information-The claim or encounter is waiting for information that has already been requested.
P4	Pending/Patient Requested Information.
	Finalized
F0	Finalized-The claim/encounter has completed the adjudication cycle and no more action will be taken.
F1	Finalized/Payment-The claim/line has been paid.
F2	Finalized/Denial-The claim/line has been denied.
F3	Finalized/Revised - Adjudication information has been changed.
F3F	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.
F3N	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.
F4	Finalized/Adjudication Complete - No payment forthcoming-The claim/encounter has been adjudicated and no further payment is forthcoming.
F5	Finalized/Cannot Process.
	Requests for additional information
R0	Requests for additional Information/General Requests-Requests that don't fall into other R-type categories.
R1	Requests for additional Information/Entity Requests-Requests for information about specific entities (subscribers, patients, various providers).
R3	Requests for additional Information/Claim/Line-Requests for information that could normally be submitted on a claim.
R4	Requests for additional Information/Documentation-Requests for additional supporting documentation. Examples: certification, x-ray, notes.
R5	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.
	General
RQ	General Questions (Yes/No Responses)-Questions that may be answered by a simple 'yes' or 'no'.
	Error
E0	Response not possible - error on submitted request data
E1	Response not possible - System Status
E2	Information Holder is not responding; Resubmit at a later time.
	Searches
D0	Entity not found - change search criteria