Chapter I: Online System Terminology

Claim Status and Location Codes

Purpose

The purpose of the status and location is to route claims through FISS.

The status describes the general condition of the claim (i.e., whether paid, denied, returned, etc.)
The location specifies where the claim resides within the system

Each status/location code is six digits in length. The status is represented by a single alpha code and the location is a five-digit alpha-numeric code.

The status code alerts the system whether or not the claim should continue processing. The following chart outlines the most common status codes providers will see.

Status Code	Description	Disposition
A	Accepted claim	No processing errors; claim continues to the next processing location. This status will be seen on the reason code file.* In essence, the reason code is inactive when this status is assigned, and the claim will not stop for further processing.*
S	Suspended claim	A manual update will be required before further processing of the claim can continue. Claims that are assigned the ‘S’ status will not appear on the provider’s remittance advice. Claims that are assigned the ‘S’ status are suspended or pending on the system, and will be identified to the provider on the 201 Pend Report.
P	Paid/processed claim	The claim has reached final disposition (paid/processed). Claims that are assigned the ‘P’ status will appear on the provider’s remittance advice.
R	Reject claim (nonmedical)	The claim has reached final disposition with no reimbursement due to nonmedical errors. Claims that are assigned the ‘R’ status will appear on both the provider’s remittance advice and the 201 Pend Report. Providers will need to adjust/resubmit rejected claims.
D	Denied claim (medical)	The claim has reached its final disposition with no reimbursement due to medical errors. This status code will only be assigned when the claim has been medically denied in full. Partial medical denials are assigned the 'P' status. Claims that are assigned the ‘D’ status will appear on both the provider’s remittance advice and the 201 Pend Report.
T	Return to provider (RTP)	The claim has reached its final disposition with no reimbursement due to billing errors. Claims that are assigned the ‘T’ status will not appear on the provider’s remittance advice. These claims will be identified to the provider in the 201 Pend Report. Providers will need to manually correct/update claims placed in this status.

The location code instructs the system to forward the claim to a specific site before any further claim activity occurs. This five-digit code is comprised of three components.

The first position identifies the type of processing occurring on the claim. Valid values for this first position of the location are:

Code	Description
M	Manual processing: This is assigned when the claim requires “in-house” processing (i.e., suspended claims).
O	Offline processing: This is assigned when the claim detail has been moved to an archived state.
B	Batch processing: This is assigned when the claim goes through FISS nightly batch processing cycles.

Positions two and three of the location represent the driver, or bucket, in which the claim is currently residing.

Valid values for this first position of the location are:

Code	Description	Code	Description
01	Status/Location	55	Utilization
02	Control	60	ADR
04	UB04 data	63	HHPS Pricer
05	Consistency (I)	65	PPS/Pricer
06	Consistency (II)	70	Payment
15	Administrative	75	Post Payment
25	Duplicate	80	MSP Primary
30	Entitlement	85	MSP Secondary
35	Lab/HCPCS	90	CWF
40	ESRD	95	Denial
50	Medical Policy	99	Session Term

Positions four and five allow for more definition within the driver for the location. Valid values for this first position of the location are:

Code	Description	Code	Description
00	Batch Process	19	Sys Research
01	Common	21	Waiver
02	Adj Orbit	65	Non DDE Pacemaker
10	Inpatient	66	DDE Pacemaker
11	Outpatient	67	DDE Home Health
12	Special Claims	96	Payment Floor
13	Med Review	97	Final Online
14	Program Review	98	Final Offline
16	MSP	99	Final Purged
18	Prod OC

The chart below identifies the most common status/location codes, which are of greatest significance to providers.

Status	Location	Definition
P	B 9996	Claim in Omnibus Budget Reconciliation Act (OBRA) hold (i.e., waiting the payment floor hold)
P	B 9997	Paid claim (finalized location)
P	O 9998	Paid claim (offline)
R	B 9997	Rejected claim (finalized location)
D	B 9997	Denied claim (finalized location)
T	B 9900	Daily return to provider (RTP) location
T	B 9997	RTP claim (finalized location)
S	B 0100	Beginning of the system (all claims start here)
S	B 2500	Claim has been updated by the provider online (awaiting duplicate check)
S	B 6000	Claim waiting for ADR to be generated
S	B 6001	Claim waiting for response from provider (ADR has already been created)
S	B 6098	Claim in an ambulance attachment online location
S	B 6099	Claim in a therapy attachment online location
S	B 9000	Claim waiting to go to CWF (has cleared all FISS edits)
S	B 9099	Awaiting response from CWF

Revised 1/31/2019