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 (5) digits of the TIN

Once the provider authentication elements have been verified, the IVR will offer the option to hear information about claims on the payment floor.

If yes, the IVR will advise if there are claims pending on payment floor, the total number of claims and the total pay amount for those claims.

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)
• Dates of service – starting and ending date

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/dates of service
• Status (processed, denied, pending, etc.)
• Received date
• Claim dates of service
• Bill type
• Total charges submitted
• Claim status and location
• Advises if claim was adjusted or cancelled
• Overlap Information (reason code starts with 38), if applicable
  • Facility Type
  • NPI
  • Claim From Date
  • Claim to Date
  • Overlapping Claim DCN
  • Overlapping Claim Cancelled Date
• CWF Overlap Information (reason codes C7010, C7050, C7080, C7595, C7565, 10416, 10422, U5390),
  if  applicable:
  • Facility Type
  • NPI
  • Claim From Date
  • Claim To Date
• CWF Adjustment Overlap Information (TOB XXG or XXH and DCN ending in N, U or Z),
  if applicable:
  • Facility Type
  • Claim From Date
  • Claim To Date
  • NPI

For additional claim information, say Claim Details (touch‐tone 1) to obtain the following, if applicable:

• Claim process date
• Whether claim processed as Medicare primary or secondary
• Claim level reason code and narrative
• Provider reimbursement amount
• Deductible and coinsurance amount applied
• Patient responsibility amount for MSP claims
• Total noncovered charges
  • If the claim contains claim lines that have denied, the provider has the option to hear details on the lines that have denied. The additional claim line information will be:
    • Revenue code
    • Procedure code, if applicable
    • Total line item charged
    • Noncovered charge
    • Liability of noncovered charge
    • Denial reason code and description
• Check number
• DCN
• Claim level liability on denied claims
• Retrieval of offline claims
• Advises if claim is suppressed
• ADR 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

Revised 3/6/2024