Inventory of Health Care Information Standards. Health Care Claim Status Codes

01/01/1997

A series of standard alphanumeric codes, and messages, that detail the status of a claim that has been submitted for payment. These codes are used in the ANSI ASC X12 Claim Status Response (277) and Payment/Advice (835) transaction sets, and in the flat file transactions associated with the UB92 and NSF formats.

Description

A composite data element comprised of the following aphanumeric and numeric data elements:

  • Health Care Claim Status Category Code -- Mandatory
  • Health Care Claim Status Code -- Mandatory
  • Entity Identfier Code -- Optional - Used when an entity is associated with the Health Care Claim Status Code

An individual code may be up to seven (7) characters long.

Readiness

Health Care Claim Adjustment Reason Code and Health Care Claim Status Codes are available in electronic and print formats:

Electronic file -

Washington Publishing Company World Wide Web Site

http://www.wpc-edi.com

Paper Copy -

Blue Cross and Blue Shield Association

Inter-Plan Teleprocessing Service

676 North St. Clair

Chicago, IL 60611

Indicator of Market Acceptance

Health Care Claim Status Code is currently in wide use within the health care community for both EDI and flat file transactions, and for both private/commercial and government programs. Codes are developed and agreed upon by committee action.

Level of Specificity

Health Care Claim Status Category Code is a 2 position alphanumeric field that is mandatory. These codes are divided into six broad categories:

  1. supplemental messages
  2. acknowledgments
  3. pending
  4. finalized
  5. requests for additional information
  6. general questions

Health Care Claim Status Code is a three position numeric code that is mandatory. There are approximately 450 codes currently available. Each code's description is understood to automatically refer to service, procedure, treatment, supply, test, visit and medication.

Entity Identfier Code is a two position alphanumeric field that is optional - Used when an entity is associated with the Health Care Claim Status Code

An individual code may be up to seven (7) characters long.

Identifiable Costs

Code lists are available at no charge from either the Washington Publishing Web Site or the Blue Cross and Blue Shield Association.