Intellect™
CLAIM STATUS CATEGORY CODES
• 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
• 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