Claim Status <2>

• If you are part of a group, remember to use the group NPI, PTAN and TIN for authentication purposes.

When Claim Status is selected, the IVR will request and collect the following elements:

• NPI
• PTAN
• Last five digits of the TIN

Once the provider authentication elements have been verified, the IVR will offer the option to hear information about pending, approved to pay and finalized claim count information.

If yes, the IVR will relay available information regarding pending, approved to pay (total amount of all claims approved to pay and total amount of claims approved to pay within 0–14 days) and finalized claims if there are claims pending on payment floor.

If no, or you have already received requested payment floor information, the IVR will request the following:

• HICN or MBI
  • Refer to the Phonetic Alphabet for assistance with speaking alpha characters
• Beneficiary first and last name (last name and first initial if using touch‐tone)
• Date of service

Once the authentication elements have been verified, the IVR will supply the following, if applicable:

• Total number of claims located for the specified Medicare number/date of service
• Claim control number
• Claim status
• Submitted amount
• Allowed amount
• Amount applied to deductible
• Payment amount
• Payment date
• Check number

For additional claim information, say Claim Details (touch‐tone 4) to obtain the following, if applicable:

• Total number of line items
• Line Item information
  • Date of service
  • Submitted amount
  • Procedure code
  • Modifier
  • ICD-10 diagnosis
  • Submitted/Allowed amount
  • Patient responsibility amount(s)-includes amount applied to coinsurance and/or amount applied to deductible
  • ADR letter information
  • Denial date
  • Denial reason
• Overlap Information
  • NPI
  • Claim From Date
  • Claim to Date
• Duplicate denial for billing NPI, if applicable
  • The IVR will provide the duplicate claim control number and the date the claim finalized
• Crossover information
  • If Medicare has a supplemental insurance on file and the claim was crossover, the following information will be provided, if applicable
  • Creation date
  • Name of supplemental insurance
  • Address
  • Effective/termination dates

If multiple claims are located, say Next Claim (touch‐tone 2) to move to the next claim and say Previous Claim (touch‐tone 3) to move back to the previous claim. For additional claims navigation options, please refer to the following chart.

Claims Navigation