PCS Product Claim Status

Batch

To convey the status of a product service claim or claims or to supply adjustment reason codes and amounts as needed for an entire claim or for a particular item within the claim

Elements

Position	Element	Name		Type	Min/Max	Repeat

1	1029	Claim Status Code	Rel	ID	1/2	1
2	559	Agency Qualifier Code	Rel	ID	2/2	1
3	822	Source Subqualifier	Opt	Alphanumeric	1/15	1
4	1172	Claim Response Reason Code	Rel	ID	1/3	1
5	782	Monetary Amount	Opt	Decimal	1/18	1
6	889	Follow-up Action Code	Opt	ID	1/1	1
7	559	Agency Qualifier Code	Rel	ID	2/2	1
8	822	Source Subqualifier	Opt	Alphanumeric	1/15	1
9	1225	Disposition Code	Rel	Alphanumeric	3/3	1
10	352	Description	Opt	Alphanumeric	1/80	1
11	553	Authorization Identification	Opt	Alphanumeric	1/4	1

Element Details

ID1029

NameClaim Status Code

LengthMin 1 / Max 2

Position1

RequirementRel

Codes

<>15Suspended - investigation with field
<>7Approved as submitted
<>CLClosed
<>25Predetermination Pricing Only - No Payment
<>28Repriced
<>13Suspended
<>14Suspended - incomplete claim
<>ROReopened
<>ADAdditional
<>22Reversal of Previous Payment
<>19Processed as Primary, Forwarded to Additional Payer(s)
<>RBReissue
<>29Audited
<>CPOpen
<>12Rejected, please resubmit with corrections
<>30Processed as Conditional
<>17Suspended - review pending
<>RCReopened and Closed
<>1Processed as Primary
<>23Not Our Claim, Forwarded to Additional Payer(s)
<>18Suspended Product Registration
<>4Denied
<>26Documentation Claim - No Payment Associated
<>16Suspended - return with material
<>2Processed as Secondary
<>20Processed as Secondary, Forwarded to Additional Payer(s)
<>5Pended
<>27Reviewed
<>8Cancelled due to inactivity
<>CCWeekly Certification
<>11Rejected, duplicate claim
<>RAReaudited
<>3Processed as Tertiary
<>21Processed as Tertiary, Forwarded to Additional Payer(s)
<>24Transferred to Proper Carrier
<>RDRedetermination
<>6Approved as amended
<>9Pending - under investigation
<>10Received, but not in process
<>APAppealed
<>IInitial

EDI Dictionary

PCS Product Claim Status

Elements

Element Details