| 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 |
| 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. (Note: A Claim Status Code identifying the type of information requested, must be reported)
Start: 01/01/1995 | Last Modified: 01/27/2008 |
| P4 | Pending/Patient Requested Information - The claim or encounter is waiting for information that has already been requested from the patient. (Note: A status code identifying the type of information requested must be sent)
Start: 01/01/1995 | Last Modified: 01/27/2008 |
| 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. (Note: A status code identifying the type of information requested must be sent)
Start: 01/30/2011 |
| 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 |
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