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

Click on any category to the left to display the codes within that category.
  • Start
    Every code has a Start date. This is the date when the code was first available in the code list.
  • Last Modified
    When populated, this is the date of the code list release when the definition of the specific code was last modified by the committee. This date represents a point when the definition changed from one wording to another.
  • Stop
    When populated, this date identifies that the code can no longer be used in original business messages after that date. The code can only be used in derivative business messages (messages where the code is being reported from the original business message). For example, a Claim Adjustment Reason Code with a Stop date of 02/01/2007 would not be able to be used by a health plan in a CAS segment in a claim payment/remittance advice transaction (835) dated after 02/01/2007 as part of an original claim adjudication (CLP02 values like “1", ”2", “3" or ”19"). The code would still be able to be used after 02/01/2007 in derivative transactions, as long as the original usage was prior to 02/01/2007. Derivative transactions include: secondary or tertiary claims (837) from the provider or health plan to a secondary or tertiary health plan, an 835 from the original health plan to the provider as a reversal of the original adjudication (CLP02 value “22”). The deactivated code is usable in these derivative transactions because they are reporting on the valid usage (pre-deactivation) of the code in a previously generated 835 transaction.
004010X093 - Health Care Claim Status Notification (277)
Claim Status Category codes are used in the Health Care Claim Status Notification (277) transaction in the STC01-1, STC10-1 and STC11-1 composite elements.
The Claim Adjustment Status Code maintenance committee meets on the Sunday of each ASC X12 trimester meeting. The meetings are held three times a year:
The Claim Adjustment Status Code Maintenance Committee
The Claim Adjustment Status Code Maintenance Committee Meeting Minutes
It is recommended that individuals pursuing a new code or changes to a code message first contact their industry representative on the committee or another committee member by email to discuss their request prior to submitting the form.

By doing so, this may facilitate their request by allowing someone familiar with the approval process to discuss an alternate solution (if appropriate) for their need, or enabling that committee member to obtain additional background information which could help with the request.

Requestors are not required to contact a committee member prior to submitting their request, but they are strongly encouraged to do so. This process allows the committee to more fully understand and discuss requests and have more time at the meeting to do so.
Use the On-Line Conference to participate in the discussions concerning code maintenance.