NOTE: Any reason code description reference to "service" is understood to automatically refer to service, procedure, treatment, supply, test, visit, and medication.

PREFIX	CATEGORY	DESCRIPTION
SECONDARY MESSAGES
X0	Supplemental Messages	Messages that may only be used to qualify another status message. These codes are NOT to be used on their own.
L00	Line level pointer	There is only one message available and it is used to point the receiver of the status message to the line level for status information (Loop 2220).
ACKNOWLEDGEMENTS
A0	Forwarded Messages	The claim/encounter has been forwarded to another entity.
A1	Receipt Messages	The claim/encounter has been received by the intended destination.
A2	Acceptance Messages	The claim/encounter has been accepted into the adjudication system.
A3	Rejection Messages	The claim/encounter has been rejected prior to entering the adjudication system.
A4	Not Found Messages	The claim/encounter cannot be found in the adjudication system.
PEND MESSAGES
P0	Pending:	The claim/encounter is being pended. Adjudication/Details This is a generic message.
P1	Pending/In Process	The claim/encounter is in the adjudication process.
P2	Pending/In Review	The claim/encounter is being reviewed (internally or externally).
P3	Pending/Requested	The claim/encounter is waiting for information that has already been requested.
FINALIZED MESSAGES
F0	Finalized	The claim/encounter has completed the adjudication cycle and no more action will be taken.
F1	Finalized/Payment	The claim/line has been paid.
F2	Finalized/Denial	The claim/line has been denied.
F3	Finalized/Forwarded/Not Forwarded	The claim has/has not been forwarded to another entity.
F4	Finalized/Adjudication Complete	The claim has been adjudicated and no payment is forthcoming.
F5	Finalized/Cannot Process	The adjudication system cannot process the claim/ encounter and no benefits will be issued.
REQUESTS FOR ADDITIONAL INFORMATION
R0	General Requests	An unsolicited status requesting additional information to allow the adjudication process to continue.
R1	Provider Requests	Request for additional information about specific providers. There are nine (9) separate sub-categories: R10 Provider R11 Facility R12 Admitting Provider R13 Surgeon, Primary Surgeon R14Assistant Surgeon R15Attending Physician R16Rendering/Covering Provider R17Referring/Prescribing Provider R18Pay-to Provider R19Primary Care Physician
R2	There are four (4) separate sub-categories: Subscriber, Patient,Spouse Requests	R20 Relationship Information R21 Subscriber R22 Patient R23 Spouse
R3	Claim/Line	There are six (6) separate sub-categories: R30 Charges, Amounts, Rates R31 Dates R32 Drug-Specific R33 Hospital-Specific R34 Dental-Specific R35 Miscellaneous
R4	Requests for Documentation	There are five (5) separate sub-categories: R40 Claims, EOBs ... R41 Medical Necessity, Reason for Treatment R42 Notes, reports, History, Charts, X-rays, Records R43 Authorization, Certification R44 Treatment Plans
YES/NO QUESTIONS
RQ	General Questions	Questions that may be answered by a simple "Yes" or "No".

Change Log

1. To gain consistency with the term "service" to include terms such as service, procedure, treatment, supply, test, visit, and medication the following changes were made:
   1. Changed Claim Status Code R315 from "Date of first visit/treatment for current series/symptom/illness." to "Date of first service for current series/symptom/illness."
   2. Changed Claim Status Code R3117 from "Date dental canal(s) opened and date procedure completed." to "Date dental canal(s) opened and date service completed."
   3. Changed Claim Status Code R347 from "Total orthodontic treatment fee, initial appliance fee, monthly fee, length of treatment." to "Total orthodontic service fee, initial appliance fee, monthly fee, length of service."
   4. Changed Claim Status Code R4210 from "Reports for procedure/service." to "Reports for service"
   5. Changed Claim Status Code R4212 from "Detailed description of procedure/service/supplies." to "Detailed description of service."
   6. Changed Claim Status Code RQ011 from "Is treatment the result of an accident?" to "Is service the result of an accident?"
   7. Changed Claim Status Code RQ013 from "Is treatment performed for a recurring condition or new condition?" to "Is service performed for a recurring condition or new condition?"
   8. Changed Claim Status Code RQ032 from "Is treatment for orthodontic purposes?" to "Is service for orthodontic purposes?"
2. Changed Claim Status Code R314 from "Date of LMP/onset of illness." to "Date of LMP/exacerbation of illness/condition."
3. Changed Claim Status Code R3512 from "Frequency of visits." to "Frequency of service."
4. Changed Claim Status Code R41 from "Medical necessity for treatment/service." to "Medical necessity for service."
5. Changed Claim Status Code R4217 from "Pathology notes." to Pathology notes/report"
6. Changed Claim Status Code R435 from "Ambulance certification." to Ambulance certification/documentation."