Health Care Claim Status Category Codes

$179 / year

This dataset explains the Claim Status Category Codes that indicate the general category of the status (accepted, rejected, additional information requested, etc.) which is further detailed in the Claim Status Codes.

Complexity

The HIPAA or Health Insurance Portability and Accountability Act of 1996, instructs medical healthcare plans to use the standard electronic transactions adopted under this agency by using the following valid standard codes.
Medicare policy requires that Claim Status Category Codes should provide a general description of each claim. If a detailed explanation is required, the Claim Status Codes will be referenced for further information on the status of a claim.

The Centers for Medicare & Medicaid Services (CMS) maintain and annually update a List of Current Procedural Terminology (CPT) / Healthcare Common Procedure Coding System (HCPCS) Codes (Code List), which identifies all the items and services included within certain DHS categories. CMS updates the Code List to conform the list to the most recent publications of CPT and HCPCS and to account for changes in Medicare coverage and payment policies. The updated Code List is published in the Federal Register as an addendum to the annual Physician Fee Schedule final rule. That rule is usually published in November and generally becomes effective January 1 of the following year. In addition, we may publish other rules or correction notices that may change the Code List. CMS posts any changes to the Code List on its webpage as soon as possible after publication in the Federal Register.

The DHS categories defined by the Code List are:
– Clinical laboratory services;
– Physical therapy services, occupational therapy services, outpatient speech-language pathology services;
– Radiology and certain other imaging services; and
– Radiation therapy services and supplies.

**NOTE**: The following DHS categories are defined at 42 CFR ยง411.351 without reference to the Code List:
– Durable medical equipment and supplies;
– Parenteral and enteral nutrients, equipment and supplies;
– Prosthetics, orthotics, and prosthetic devices and supplies;
– Home health services;
– Outpatient prescription drugs; and
– Inpatient and outpatient hospital services.

Date Created

1995

Last Modified

2020-03-01

Version

2020-03-01

Update Frequency

Irregular

Temporal Coverage

1995-2019

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicare and Medicaid Services;

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

Claim status category codes, CSCC, ASC X12 External Code Source 507, Claims Adjudication, Disposition Codes

Other Titles

Health Insurance Portability and Accountability Act (HIPAA) standard electronic transactions, Medicare appropriate Claim Status Category Codes, General explanation of claim status codes, General category of Claim Status Category Codes, Claims Adjudication and Claim Status Category Codes, Disposition Codes and Claim Status Category Codes

NameDescriptionTypeConstraints
CodeClaim Status Category Codesstringrequired : 1 unique : 1
DescriptionDescription for each Claim Status Category Codestringrequired : 1
CategoryCategory of the Claim Status Category Codesstringrequired : 1
Start_DateDate the Claim Status Category Code started usagedaterequired : 1
Last_ModifiedDate the Claim Status Category Code was changed/modifieddate-
Stop_DateDate the Claim Status Category Code was deactivated/stoppeddate-
StatusCode update whether Active, To be Deactivated or Deactivatedstringrequired : 1
NotesExplanation to redundant and/or replacement Claim Status Category Codestring-
CodeDescriptionCategoryStart DateLast ModifiedStop DateStatusNotes
X0Supplemental MessagesSupplemental1995-01-012003-10-16Deactivated
A0Acknowledgement/Forwarded-The claim/encounter has been forwarded to another entity.Acknowledgements1995-01-01Active
A1Acknowledgement/Receipt-The claim/encounter has been received. This does not mean that the claim has been accepted for adjudication.Acknowledgements1995-01-01Active
A2Acknowledgement/Acceptance into adjudication system-The claim/encounter has been accepted into the adjudication system.Acknowledgements1995-01-01Active
A3Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system.Acknowledgements1995-01-01Active
A4Acknowledgement/Not Found-The claim/encounter can not be found in the adjudication system.Acknowledgements1995-01-01Active
A5Acknowledgement/Split Claim-The claim/encounter has been split upon acceptance into the adjudication system.Acknowledgements2002-02-28Active
A6Acknowledgement/Rejected for Missing Information - The claim/encounter is missing the information specified in the Status details and has been rejected.Acknowledgements2002-10-31Active
A7Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected.Acknowledgements2002-10-31Active
A8Acknowledgement / Rejected for relational field in error.Acknowledgements2004-10-31Active