- Introduction
- Chapter I - Online System Terminology
- Chapter II - Online Menu Functions Overview
- Chapter III - Navigating the Online System
- Chapter IV - Inquiries Submenu (01)
- Accessing the Inquiries Submenu
- Beneficiary/CWF (10)
- DRG (Pricer/Grouper) (11)
- Claim Summary (12)
- Revenue Codes (13)
- HCPCS Codes (14)
- DX/Proc Codes ICD-9 (15)
- Adjustment Reason Codes (16)
- Reason Codes (17)
- ZIP Code File (19)
- OSC Repository Inquiry (1A)
- Claim Count Summary (56)
- Home Health Payment Totals (67)
- ANSI Reason Codes (68)
- Invoice Number/DCN Translator (88)
- DX Proc Codes ICD-10 (1B)
- Community Mental Health Centers Services Payment Totals (1C)
- Check History (FI)
- Provider Practice Address Query (1D)
- New HCPCS Screen (1E)
- Opioid Use Disorder (OUD) Demo 99 (1F)
- Chapter V - Claims and Attachments Submenu (02)
- Chapter VI - Claims Correction Submenu (03)
- Chapter VII - Online Reports View Submenu (04)
- Resources
- Part A Electronic Medicare Secondary and Tertiary Payer Specifications for ANSI Inbound Claim
- Electronic Medicare Secondary Payer Specifications for Inbound Claims
- FISS UB-04 Data Entry Payer Codes
- Common Claim Status/Locations
- FISS Reason Code Overview
- FISS Reason Code/Claim Driver Overview
- Program Function/Escape Key Crosswalk
- How to Adjust a Claim
- FISS Claim Change/Condition Reason Codes
- How to Cancel a Claim
- How to Correct a Return to Provider Claim
- Online System Menu Quick-Reference
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