• Supplemental
    • X0 Supplemental Messages
      Start: 1/1/1995
      Stop: 10/16/2003
  • Acknowledgements
    • A0 Acknowledgement/Forwarded-The claim/encounter has been forwarded to another entity.
      Start: 1/1/1995
    • A1 Acknowledgement/Receipt-The claim/encounter has been received. This does not mean that the claim has been accepted for adjudication.
      Start: 1/1/1995
    • A2 Acknowledgement/Acceptance into adjudication system-The claim/encounter has been accepted into the adjudication system.
      Start: 1/1/1995
    • A3 Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system.
      Start: 1/1/1995
    • A4 Acknowledgement/Not Found-The claim/encounter can not be found in the adjudication system.
      Start: 1/1/1995
    • A5 Acknowledgement/Split Claim-The claim/encounter has been split upon acceptance into the adjudication system.
      Start: 2/28/2002
    • 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: 1/1/1995
    • P1 Pending/In Process-The claim or encounter is in the adjudication system.
      Start: 1/1/1995
    • P2 Pending/In Review-The claim/encounter is suspended pending review. This change to be effective 7/1/2008: Pending/Payer Review-The claim/encounter is suspended and is pending review (e.g. medical review, repricing, Third Party Administrator processing).
      Start: 1/1/1995
      Last Modified: 1/27/2008
    • P3 Pending/Requested Information-The claim or encounter is waiting for information that has already been requested. This change to be effective 7/1/2008: 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: 1/1/1995
      Last Modified: 1/27/2008
    • P4 Pending/Patient Requested Information. This change to be effective 7/1/2008: 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: 1/1/1995
      Last Modified: 1/27/2008
    • 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: 1/1/1995
    • F1 Finalized/Payment-The claim/line has been paid.
      Start: 1/1/1995
    • F2 Finalized/Denial-The claim/line has been denied.
      Start: 1/1/1995
    • F3 Finalized/Revised - Adjudication information has been changed
      Start: 2/28/2001
    • 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: 1/1/1995
    • 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: 1/1/1995
    • F4 Finalized/Adjudication Complete - No payment forthcoming-The claim/encounter has been adjudicated and no further payment is forthcoming.
      Start: 1/1/1995
    • F5 Finalized/Cannot Process
      Start: 1/1/1995
      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: 1/1/1995
    • R1 Requests for additional Information/Entity Requests-Requests for information about specific entities (subscribers, patients, various providers).
      Start: 1/1/1995
    • R3 Requests for additional Information/Claim/Line-Requests for information that could normally be submitted on a claim.
      Start: 1/1/1995
      Last Modified: 2/28/1998
    • R4 Requests for additional Information/Documentation-Requests for additional supporting documentation. Examples: certification, x-ray, notes.
      Start: 1/1/1995
      Last Modified: 2/28/1998
    • 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: 1/1/1995
      Last Modified: 6/30/1998
    • R6 Requests for additional information – Regulatory requirements
      Start: 2/28/2007
    • R7 Requests for additional information – Confirm care is consistent with Health Plan policy coverage
      Start: 2/28/2007
    • R8 Requests for additional information – Confirm care is consistent with health plan coverage exceptions
      Start: 2/28/2007
    • R9 Requests for additional information – Determination of medical necessity
      Start: 2/28/2007
    • R10 Requests for additional information – Support a filed grievance or appeal
      Start: 2/28/2007
    • R11 Requests for additional information – Pre-payment review of claims
      Start: 2/28/2007
    • R12 Requests for additional information – Clarification or justification of use for specified procedure code
      Start: 2/28/2007
    • R13 Requests for additional information – Original documents submitted are not readable. Used only for subsequent request(s).
      Start: 2/28/2007
    • R14 Requests for additional information – Original documents received are not what was requested. Used only for subsequent request(s).
      Start: 2/28/2007
    • R15 Requests for additional information – Workers Compensation coverage determination.
      Start: 2/28/2007
    • R16 Requests for additional information – Eligibility determination
      Start: 2/28/2007
  • General
    • RQ General Questions (Yes/No Responses)-Questions that may be answered by a simple 'yes' or 'no'.
      Start: 1/1/1995
      Stop: 1/1/2008
      Last Modified: 7/9/2007
  • Error
    • E0 Response not possible - error on submitted request data
      Start: 1/1/1995
      Last Modified: 2/28/2002
    • E1 Response not possible - System Status
      Start: 2/29/2000
    • E2 Information Holder is not responding; resubmit at a later time.
      Start: 6/30/2003
  • Searches
    • D0 Entity not found - change search criteria
      Start: 1/1/1995
      Last Modified: 2/28/2002