Emdeon Version 4 Standard Claim Status Response

Transcription

1 Emdeon Version 4 Standard Claim Status Response POS Response Dictionary Emdeon Tranz Multipayers and VeriFone terminals Fax-on-Demand #5995

2 This publication is the proprietary property of Emdeon and is furnished solely for use pursuant to a license agreement giving the user the right to use the Emdeon product(s) referenced in this document. All uses of this document are subject to the terms of such license agreement. This document may not be used except as permitted by such license agreement or changed, copied, photocopied, reproduced, translated, or reduced to any electronic medium or machine readable form without the prior consent of Emdeon. Copyright is held by Emdeon Business Services, LLC. Emdeon is not liable for any losses or damages that result from the use of this material, including loss of profit or indirect, special, or consequential damages.

3 Table of Contents Table of Contents Introduction About This Document Customer Support Fax-on-Demand Documentation on the Web Input Information Payer Information (heading varies) Claim Record Information Index Emdeon Business Services LLC. All rights reserved. Page i

4 Introduction Introduction About This Document This document serves as a dictionary of the standard claim status response data elements returned in Emdeon Version 4 standard claim status responses received through your Emdeon Tranz multipayer terminal or Vx570 terminal. 1 All of the items described in this response explanation will not appear in every response. A payer can omit fields or sections from the response, or can tailor the specific data returned. For a synopsis of the data returned for a specific payer s claim status response, see the specific Claim Status Transaction Guide for that payer. Note: This document does not cover responses that are not in the Emdeon Version 4 standard claim status response format. Those responses are documented in the payer s Transaction Guide. For a dictionary of transaction-related errors, see the Dictionary of Transaction Error Messages (Fax on Demand document # 5997). Customer Support customer.service@emdeon.com Fax-on-Demand You can receive this and other POS Tranz documentation through the Emdeon Fax on Demand service at To order this document, request number Documentation on the Web These documents are also available from our website at Choose the category Standard Response Guides. 1 Tranz and Vx570 are registered trademarks of VeriFone, Inc Emdeon Business Services LLC. All rights reserved. Page 1

5 Input Information The Input Information section lists the input prompts in the query and the data you entered in response to them. Payer Information (heading varies) This section is typically labeled with the payer s name. Xtn ID The original application transaction identifier; used to trace a transaction from point to point. Date The date the payer or fiscal intermediary generated the transaction, in MM/DD/CCYY format. Payer ID The payer s primary identification number. No Heading (Payer) The payer s name. No Heading (Contact Number) The phone number by which to contact the payer, in or format. Req ID The requester s primary identification number. Req Name The last name or organization name of the requester. First The requester s first name, if the requester is a person. Middle The requester s middle initial, if the requester is a person. Svc Prov ID The primary identification number of the service provider. Svc Prov Name The last name or organization name of the service provider. First The service provider s first name. Middle The service provider s middle name Emdeon Business Services LLC. All rights reserved. Page 2

6 Sub ID The primary identification number of the subscriber. Emdeon Version 4 Standard Claim Status Response POS Response Dictionary Last The subscriber s last name. First The subscriber s first name. Middle The subscriber s middle name. DOB The subscriber s date of birth, in MM/DD/CCYY format. Sub Gender The subscriber s gender: Female Male Unknown Pat ID The primary identification number of the patient. Last The patient s last name. First The patient s first name. Middle The patient s middle name. DOB The patient s date of birth, in MM/DD/CCYY format. Gender The patient s gender: Female Male Unknown Claim Record Information The Claim Record section contains details about a claim. Up to 99 Claim Record sections can appear. Claim # The payer s claim control number. Trce1 The audit number the payer or fiscal intermediary has assigned to identify the transaction Emdeon Business Services LLC. All rights reserved. Page 3

7 No Heading (Origin) The originator of the trace number. No Heading (Origin Description) Additional information about the originator of the trace number. Statement Period Begin The beginning date of the claim statement period, in MM/DD/CCYY format. Statement Period End The ending date of the claim statement period, in MM/DD/CCYY format. Effective Date The effective date of the status information for this claim, in MM/DD/CCYY format. Entity The entity associated with the following claim record. Category The code denoting the category of the status information that follows. No Heading (Category Description) A description of the category of the status information that follows. Status The code denoting the status of the claim. No Heading (Status Description) The description of the status of the claim. Total Charge The total amount of the claim charge. Claim Payment The amount of the claim payment. Adjudication Date The claim adjudication or payment date, in MM/DD/CCYY format. Pay Method The code for the payment method. No Heading (Pay Method Description) A description of the payment method. Check/Issue Date The check issue or EFT effective date of the claim payment, in MM/DD/CCYY format. Check/EFT # The check or EFT trace number of the claim payment Emdeon Business Services LLC. All rights reserved. Page 4

8 No Heading (Entity 2) The entity associated with the second claim record. Emdeon Version 4 Standard Claim Status Response POS Response Dictionary Category 2 The code denoting the category of the following status information regarding the second claim. No Heading (Category 2 Description) A description of the category of the following status information regarding the second claim. Status 2 The code denoting the status of the second claim. No Heading (Status 2 Description) The description of the status of the second claim. Bill Type The bill type indicator for the claim. Med Rec # The associated medical record number. The following fields reflect line item detail for the claim. If there are two line items reported for the same claim, you will see an additional Claim Record segment heading followed by the line item detail. The claim information, described above, will not repeat. Prod/Svc Sce A code denoting the type or source of the product or service ID that follows. Prod/Svc The product or service ID for the line item. Prod/Svc Mod 1 The first modifier for the preceding line item product or service. Prod/Svc Mod 2 The second modifier for the preceding line item product or service. Prod/Svc Mod 3 The third modifier for the preceding line item product/service. Prod/Svc Mod 4 The fourth modifier for the preceding line item product or service. Prod/Svc Charge The line item charge amount submitted for the preceding product or service. Prod/Svc Payment The payment amount for the preceding line item product or service. Revenue Code The NUBC revenue code Emdeon Business Services LLC. All rights reserved. Page 5

9 Qty The number of original submitted units. Emdeon Version 4 Standard Claim Status Response POS Response Dictionary Effective Date The effective date of the status information, in MM/DD/CCYY format. Line Item Entity The entity associated with the line item. Line Item Ctgy The code denoting the category of the line item status information that follows. No Heading (Line Item Category Description) The description of the category of the line item status information that follows. Line Item Status The code denoting the status of the line item. No Heading (Line Item Status Description) The description of the status of the line item. Line Item Entity 2 The entity associated with the second line item. Line Item Ctgy 2 The code denoting the category of the line item status information that follows. No Heading (Line Item Category Description) The description of the category of the line item status information that follows. Line Item Status 2 The code denoting the status of the second line item. No Heading (Line Item Status Description) The description of the status of the second line item. Line Item Entity 3 The entity associated with the third line item. Line Item Ctgy 3 The code denoting the category of the line item status information that follows. No Heading (Line Item Category Description) The description of the category of the line item status information that follows. Line Item Status 3 The code denoting the status of the third line item. No Heading (Line Item Status Description) The description of the status of the line item Emdeon Business Services LLC. All rights reserved. Page 6

10 Line Item Charge The line item charge amount. Line Item Payment The line item payment amount. Line Item The line item control number. Line Item Date The dates of service or begin date of the line item product or service, in MM/DD/CCYY-MM/DD/CCYY format Emdeon Business Services LLC. All rights reserved. Page 7

11 Index Index A About This Document, 1 C Claim Record Information, 3 Customer Support, 1 D Documentation, 1 Documentation on the Web, 1 F Fax-on-Demand, 1 I Input Information, 2 P Payer Information (heading varies), Emdeon Business Services LLC. All rights reserved. Page 8

12 Emdeon is a leading provider of revenue and payment cycle solutions that connect payers, providers, and patients to improve the healthcare business processes. To learn more about our company, our services, and our commitment to improving healthcare, visit our website at Emdeon Business Services LLC. All rights reserved Lebanon Pike, Suite 1000 Nashville, TN EMDEON.6 ( )