PCS Product Claim Status
Opt
AtMax 1
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 | AtMax 1 |
| 2 | 559 | Agency Qualifier Code | Rel | ID | 2/2 | AtMax 1 |
| 3 | 822 | Source Subqualifier | Opt | Alphanumeric | 1/15 | AtMax 1 |
| 4 | 1172 | Claim Response Reason Code | Rel | ID | 1/3 | AtMax 1 |
| 5 | 782 | Monetary Amount | Opt | Decimal | 1/18 | AtMax 1 |
| 6 | 889 | Follow-up Action Code | Opt | ID | 1/1 | AtMax 1 |
| 7 | 559 | Agency Qualifier Code | Rel | ID | 2/2 | AtMax 1 |
| 8 | 822 | Source Subqualifier | Opt | Alphanumeric | 1/15 | AtMax 1 |
| 9 | 1225 | Disposition Code | Rel | Alphanumeric | 3/3 | AtMax 1 |
| 10 | 352 | Description | Opt | Alphanumeric | 1/80 | AtMax 1 |
| 11 | 553 | Authorization Identification | Opt | Alphanumeric | 1/4 | AtMax 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
- <>31Not Our Claim, Unable to Forward
- <>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