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Claim Status Category Codes

X12 External Code Source 507

These codes organize the Claim Status Codes (ECL 139) into logical groupings.

Last updated: 3/3/2020

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The list below shows the status of change requests which are in process.

Each request will be in one of the following statuses:

  1. Received
    The request has been submitted but is not yet under review.
  2. Triaged
    Staff has looked at the request to ensure it's a legitimate request (not spam), that it is assigned to the correct CMG, and that all required information is present.
  3. In Process
    The CMG has initiated their decision process.
  4. On Hold
    The CMG has initiated their decision process but cannot complete it at this time.
  5. CMG Approved
    The CMG has considered and approved the request, this does not mean it was approved exactly as submitted, it means maintenance related to the request was approved. Requests in this status will be applied to the next version.
  6. CMG Disapproved
    The CMG has considered and disapproved the request, no maintenance action will occur. Requests in this status are complete/final.
No current requests. This list has been stable since the last update. It will not be updated until there are new requests.
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Use the form below to request maintenance to the Code List. Maintenance includes a request for a new code, a revision to the description of code, or deactivation of a code.

Note
The information submitted on this form may be edited for clarity or accuracy during the X12 triage and consideration processes.

Fields marked with an asterisk are required. Existing Code is required on requests for revision or deactivation of a code.

* Name
* Phone
* Email
* Request Type
Existing Code

* Brief description, published with the Code

Extended description, published with the Code

* Include the business justification for this maintenance request here, including who would benefit and the circumstances that make the request appropriate or necessary.

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Supplemental
X0Supplemental Messages
Start: 01/01/1995 | Stop: 10/16/2003
Acknowledgements
A0Acknowledgement/Forwarded-The claim/encounter has been forwarded to another entity.
Start: 01/01/1995
A1Acknowledgement/Receipt-The claim/encounter has been received. This does not mean that the claim has been accepted for adjudication.
Start: 01/01/1995
A2Acknowledgement/Acceptance into adjudication system-The claim/encounter has been accepted into the adjudication system.
Start: 01/01/1995
A3Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system.
Start: 01/01/1995
A4Acknowledgement/Not Found-The claim/encounter can not be found in the adjudication system.
Start: 01/01/1995
A5Acknowledgement/Split Claim-The claim/encounter has been split upon acceptance into the adjudication system.
Start: 02/28/2002
A6Acknowledgement/Rejected for Missing Information - The claim/encounter is missing the information specified in the Status details and has been rejected.
Start: 10/31/2002
A7Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected.
Start: 10/31/2002
A8Acknowledgement/Rejected for relational field in error.
Start: 10/31/2004
Data Reporting Acknowledgments
DR01Acknowledgement/Receipt - The claim/encounter has been received. This does not mean the claim has been accepted into the data reporting/processing system. Usage: Can only be used in the Data Reporting Acknowledgement Transaction.
Start: 07/01/2018
DR02Acknowledgement/Acceptance into the data reporting/processing system - The claim/encounter has been accepted into the data reporting/processing system. Usage: Can only be used in the Data Reporting Acknowledgment Transaction.
Start: 07/01/2018
DR03Acknowledgement/Returned as unprocessable claim - The claim/encounter has been rejected and has not been entered into the data reporting/processing system. Usage: Can only be used in the Data Reporting Acknowledgment Transaction.
Start: 07/01/2018
DR04Acknowledgement/Not Found - The claim/encounter can not be found in the data reporting/processing system. Usage: Can only be used in the Data Reporting Acknowledgment Transaction.
Start: 07/01/2018
DR05Acknowledgement/Rejected for Missing Information - The claim/encounter is missing the information specified in the Status details and has been rejected. Usage: Can only be used in the Data Reporting Acknowledgment Transaction.
Start: 07/01/2018
DR06Acknowledgment/Rejected for invalid information - The claim/encounter has invalid information as specified in the Status details and has been rejected. Usage: Can only be used in the Data Reporting Acknowledgment Transaction.
Start: 07/01/2018
DR07Acknowledgement/Rejected for relational field in error. Usage: Can only be used in the Data Reporting Acknowledgment Transaction.
Start: 07/01/2018
DR08Acknowledgement/Warning - The claim/encounter has been accepted into the data reporting/processing system but has received a warning as specified in the Status details. Usage: Can only be used in the Data Reporting Acknowledgment Transaction.
Start: 07/01/2018
Pending
P0Pending: 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
P1Pending/In Process-The claim or encounter is in the adjudication system.
Start: 01/01/1995
P2Pending/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
P3Pending/Provider Requested Information - The claim or encounter is waiting for information that has already been requested from the provider. (Usage: A Claim Status Code identifying the type of information requested, must be reported)
Start: 01/01/1995 | Last Modified: 07/01/2017
P4Pending/Patient Requested Information - The claim or encounter is waiting for information that has already been requested from the patient. (Usage: A status code identifying the type of information requested must be sent)
Start: 01/01/1995 | Last Modified: 07/01/2017
P5Pending/Payer Administrative/System hold
Start: 10/31/2006
Finalized
F0Finalized-The claim/encounter has completed the adjudication cycle and no more action will be taken.
Start: 01/01/1995
F1Finalized/Payment-The claim/line has been paid.
Start: 01/01/1995
F2Finalized/Denial-The claim/line has been denied.
Start: 01/01/1995
F3Finalized/Revised - Adjudication information has been changed
Start: 02/28/2001
F3FFinalized/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
F3NFinalized/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
F4Finalized/Adjudication Complete - No payment forthcoming-The claim/encounter has been adjudicated and no further payment is forthcoming.
Start: 01/01/1995
F5Finalized/Cannot Process
Start: 01/01/1995 | Stop: 10/16/2003
Requests for additional information
R0Requests for additional Information/General Requests-Requests that don't fall into other R-type categories.
Start: 01/01/1995
R1Requests for additional Information/Entity Requests-Requests for information about specific entities (subscribers, patients, various providers).
Start: 01/01/1995
R3Requests 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
R4Requests for additional Information/Documentation-Requests for additional supporting documentation. Examples: certification, x-ray, notes.
Start: 01/01/1995 | Last Modified: 02/28/1998
R5Request 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
R6Requests for additional information – Regulatory requirements
Start: 02/28/2007
R7Requests for additional information – Confirm care is consistent with Health Plan policy coverage
Start: 02/28/2007
R8Requests for additional information – Confirm care is consistent with health plan coverage exceptions
Start: 02/28/2007
R9Requests for additional information – Determination of medical necessity
Start: 02/28/2007
R10Requests for additional information – Support a filed grievance or appeal
Start: 02/28/2007
R11Requests for additional information – Pre-payment review of claims
Start: 02/28/2007
R12Requests for additional information – Clarification or justification of use for specified procedure code
Start: 02/28/2007
R13Requests for additional information – Original documents submitted are not readable. Used only for subsequent request(s).
Start: 02/28/2007
R14Requests for additional information – Original documents received are not what was requested. Used only for subsequent request(s).
Start: 02/28/2007
R15Requests for additional information – Workers Compensation coverage determination.
Start: 02/28/2007
R16Requests for additional information – Eligibility determination
Start: 02/28/2007
R17Replacement of a Prior Request. Used to indicate that the current attachment request replaces a prior attachment request.
Start: 01/20/2013
General
RQGeneral 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
E0Response not possible - error on submitted request data
Start: 01/01/1995 | Last Modified: 02/28/2002
E1Response not possible - System Status
Start: 02/29/2000
E2Information Holder is not responding; resubmit at a later time.
Start: 06/30/2003
E3Correction required - relational fields in error.
Start: 01/24/2010
E4Trading partner agreement specific requirement not met: Data correction required. (Usage: A status code identifying the type of information requested must be sent)
Start: 01/30/2011 | Last Modified: 07/01/2017
Searches
D0Data 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