Status Last Reviewed: 12/1/2024
| Num. | Date | Requested Description | Type | Code | Status |
|---|---|---|---|---|---|
| No current requests. This list has been stable since the last update. It will not be updated until there are new requests. | |||||
Claim Status Category Codes
507
These codes organize the Claim Status Codes (ECL 508) into logical groupings.
Maintenance Request Status
Maintenance Request Status
The list below shows the status of change requests which are in process.
Each request will be in one of the following statuses:
- Received
The request has been submitted but is not yet under review. - Pending
Staff has looked at the request to ensure it's a legitimate request (not spam), that it is assigned to the correct CMG, and that all required information is present. - In Process
The CMG has initiated their decision process. - On Hold
The CMG has initiated their decision process but cannot complete it at this time. - CMG Approved
The CMG has considered and approved the request, this does not mean it was approved exactly as submitted, it means maintenance related to the request was approved. Requests in this status will be applied to the next version. - CMG Disapproved
The CMG has considered and disapproved the request, no maintenance action will occur. Requests in this status are complete/final.
Maintenance Request Form
Claim Status Category Codes
3/3/2020
| Supplemental | |
| X0 | Supplemental Messages Start: 01/01/1995 | Stop: 10/16/2003 |
| Acknowledgements | |
| A0 | Acknowledgement/Forwarded-The claim/encounter has been forwarded to another entity. Start: 01/01/1995 |
| A1 | Acknowledgement/Receipt-The claim/encounter has been received. This does not mean that the claim has been accepted for adjudication. Start: 01/01/1995 |
| A2 | Acknowledgement/Acceptance into adjudication system-The claim/encounter has been accepted into the adjudication system. Start: 01/01/1995 |
| A3 | Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system. Start: 01/01/1995 |
| A4 | Acknowledgement/Not Found-The claim/encounter can not be found in the adjudication system. Start: 01/01/1995 |
| A5 | Acknowledgement/Split Claim-The claim/encounter has been split upon acceptance into the adjudication system. Start: 02/28/2002 |
| A6 | Acknowledgement/Rejected for Missing Information - The claim/encounter is missing the information specified in the Status details and has been rejected. Start: 10/31/2002 |
| A7 | Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected. Start: 10/31/2002 |
| A8 | Acknowledgement/Rejected for relational field in error. Start: 10/31/2004 |
| Data Reporting Acknowledgments | |
| DR01 | Acknowledgement/Receipt - The claim/encounter has been received. This does not mean the claim has been accepted into the data reporting/processing system. Usage: Can only be used in the Data Reporting Acknowledgement Transaction. Start: 07/01/2018 |
| DR02 | Acknowledgement/Acceptance into the data reporting/processing system - The claim/encounter has been accepted into the data reporting/processing system. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018 |
| DR03 | Acknowledgement/Returned as unprocessable claim - The claim/encounter has been rejected and has not been entered into the data reporting/processing system. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018 |
| DR04 | Acknowledgement/Not Found - The claim/encounter can not be found in the data reporting/processing system. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018 |
| DR05 | Acknowledgement/Rejected for Missing Information - The claim/encounter is missing the information specified in the Status details and has been rejected. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018 |
| DR06 | Acknowledgment/Rejected for invalid information - The claim/encounter has invalid information as specified in the Status details and has been rejected. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018 |
| DR07 | Acknowledgement/Rejected for relational field in error. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018 |
| DR08 | Acknowledgement/Warning - The claim/encounter has been accepted into the data reporting/processing system but has received a warning as specified in the Status details. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018 |
| 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. Start: 01/01/1995 |
| P1 | Pending/In Process-The claim or encounter is in the adjudication system. Start: 01/01/1995 |
| P2 | Pending/Payer Review-The claim/encounter is suspended and is pending review (e.g. medical review, repricing, Third Party Administrator processing). Start: 01/01/1995 | Last Modified: 01/27/2008 |
| P3 | Pending/Provider Requested Information - The claim or encounter is waiting for information that has already been requested from the provider. (Usage: A Claim Status Code identifying the type of information requested, must be reported) Start: 01/01/1995 | Last Modified: 07/01/2017 |
| P4 | Pending/Patient Requested Information - The claim or encounter is waiting for information that has already been requested from the patient. (Usage: A status code identifying the type of information requested must be sent) Start: 01/01/1995 | Last Modified: 07/01/2017 |
| P5 | Pending/Payer Administrative/System hold Start: 10/31/2006 |
| Finalized | |
| F0 | Finalized-The claim/encounter has completed the adjudication cycle and no more action will be taken. Start: 01/01/1995 |
| F1 | Finalized/Payment-The claim/line has been paid. Start: 01/01/1995 |
| F2 | Finalized/Denial-The claim/line has been denied. Start: 01/01/1995 |
| F3 | Finalized/Revised - Adjudication information has been changed Start: 02/28/2001 |
| 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. Start: 01/01/1995 |
| 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. Start: 01/01/1995 |
| F4 | Finalized/Adjudication Complete - No payment forthcoming-The claim/encounter has been adjudicated and no further payment is forthcoming. Start: 01/01/1995 |
| F5 | Finalized/Cannot Process Start: 01/01/1995 | Stop: 10/16/2003 |
| Requests for additional information | |
| R0 | Requests for additional Information/General Requests-Requests that don't fall into other R-type categories. Start: 01/01/1995 |
| R1 | Requests for additional Information/Entity Requests-Requests for information about specific entities (subscribers, patients, various providers). Start: 01/01/1995 |
| R3 | Requests for additional Information/Claim/Line-Requests for information that could normally be submitted on a claim. Start: 01/01/1995 | Last Modified: 02/28/1998 |
| R4 | Requests for additional Information/Documentation-Requests for additional supporting documentation. Examples: certification, x-ray, notes. Start: 01/01/1995 | Last Modified: 02/28/1998 |
| 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. Start: 01/01/1995 | Last Modified: 06/30/1998 |
| R6 | Requests for additional information – Regulatory requirements Start: 02/28/2007 |
| R7 | Requests for additional information – Confirm care is consistent with Health Plan policy coverage Start: 02/28/2007 |
| R8 | Requests for additional information – Confirm care is consistent with health plan coverage exceptions Start: 02/28/2007 |
| R9 | Requests for additional information – Determination of medical necessity Start: 02/28/2007 |
| R10 | Requests for additional information – Support a filed grievance or appeal Start: 02/28/2007 |
| R11 | Requests for additional information – Pre-payment review of claims Start: 02/28/2007 |
| R12 | Requests for additional information – Clarification or justification of use for specified procedure code Start: 02/28/2007 |
| R13 | Requests for additional information – Original documents submitted are not readable. Used only for subsequent request(s). Start: 02/28/2007 |
| R14 | Requests for additional information – Original documents received are not what was requested. Used only for subsequent request(s). Start: 02/28/2007 |
| R15 | Requests for additional information – Workers Compensation coverage determination. Start: 02/28/2007 |
| R16 | Requests for additional information – Eligibility determination Start: 02/28/2007 |
| R17 | Replacement of a Prior Request. Used to indicate that the current attachment request replaces a prior attachment request. Start: 01/20/2013 |
| General | |
| RQ | General Questions (Yes/No Responses)-Questions that may be answered by a simple 'yes' or 'no'. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008 |
| Error | |
| E0 | Response not possible - error on submitted request data Start: 01/01/1995 | Last Modified: 02/28/2002 |
| E1 | Response not possible - System Status Start: 02/29/2000 |
| E2 | Information Holder is not responding; resubmit at a later time. Start: 06/30/2003 |
| E3 | Correction required - relational fields in error. Start: 01/24/2010 |
| E4 | Trading partner agreement specific requirement not met: Data correction required. (Usage: A status code identifying the type of information requested must be sent) Start: 01/30/2011 | Last Modified: 07/01/2017 |
| Searches | |
| D0 | Data Search Unsuccessful - The payer is unable to return status on the requested claim(s) based on the submitted search criteria. Start: 01/01/1995 | Last Modified: 09/20/2009 |