Zenbridge
EDI Dictionary

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

PositionElementNameTypeMin/MaxRepeat
11029Claim Status CodeRelID1/21
2559Agency Qualifier CodeRelID2/21
3822Source SubqualifierOptAlphanumeric1/151
41172Claim Response Reason CodeRelID1/31
5782Monetary AmountOptDecimal1/181
6889Follow-up Action CodeOptID1/11
7559Agency Qualifier CodeRelID2/21
8822Source SubqualifierOptAlphanumeric1/151
91225Disposition CodeRelAlphanumeric3/31
10352DescriptionOptAlphanumeric1/801
11553Authorization IdentificationOptAlphanumeric1/41

Element Details

ID1029
NameClaim Status Code
LengthMin 1 / Max 2
Position1
RequirementRel
Codes
  • <>15
    Suspended - investigation with field
  • <>7
    Approved as submitted
  • <>CL
    Closed
  • <>25
    Predetermination Pricing Only - No Payment
  • <>28
    Repriced
  • <>13
    Suspended
  • <>31
    Not Our Claim, Unable to Forward
  • <>14
    Suspended - incomplete claim
  • <>RO
    Reopened
  • <>AD
    Additional
  • <>22
    Reversal of Previous Payment
  • <>19
    Processed as Primary, Forwarded to Additional Payer(s)
  • <>RB
    Reissue
  • <>29
    Audited
  • <>CP
    Open
  • <>12
    Rejected, please resubmit with corrections
  • <>30
    Processed as Conditional
  • <>17
    Suspended - review pending
  • <>RC
    Reopened and Closed
  • <>1
    Processed as Primary
  • <>23
    Not Our Claim, Forwarded to Additional Payer(s)
  • <>18
    Suspended Product Registration
  • <>4
    Denied
  • <>26
    Documentation Claim - No Payment Associated
  • <>16
    Suspended - return with material
  • <>2
    Processed as Secondary
  • <>20
    Processed as Secondary, Forwarded to Additional Payer(s)
  • <>5
    Pended
  • <>27
    Reviewed
  • <>8
    Cancelled due to inactivity
  • <>CC
    Weekly Certification
  • <>11
    Rejected, duplicate claim
  • <>RA
    Reaudited
  • <>3
    Processed as Tertiary
  • <>21
    Processed as Tertiary, Forwarded to Additional Payer(s)
  • <>24
    Transferred to Proper Carrier
  • <>RD
    Redetermination
  • <>6
    Approved as amended
  • <>9
    Pending - under investigation
  • <>10
    Received, but not in process
  • <>AP
    Appealed
  • <>I
    Initial