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RDA Position: Indicates which position this adjustment is located in on the claim. This value is assigned by RDA.
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RDA Position: Indicates which position this mcs audit is located in on the claim. This value is assigned by RDA.
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DATE
DECIMAL
DECIMAL
DECIMAL
DECIMAL
DATE
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Non-assigned claim submitted with both clinical lab and non-clinical lab services (the system will auto split these during the batch process and revise the assignment indicator to ‘A’ and ‘N’). This value applies only to pending claim records.
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DATE
DATE
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Note: Not on original claim.
RDA Position: Indicates which position this diagnosis code is located in on the claim. This value is assigned by RDA.
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RDA Position: Indicates which position this mcs location is located in on the claim. This value is assigned by RDA.
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Current active claim. This is an internal MCS MPAP status, and will only display online in related history.
Suspended. All pending claims will show this status when they are viewed online. All other pending claim statuses are used internally by MCS MPAP only.
Approved awaiting CWF response through MPAP, claim processed with no outstanding edits/audits through MPAP and queried.
Approved and paid; CAP physician no pay detail lines.
Denied; set based on the history usage indicator on the AA segment of a denial edit or audit.
Full claim refund - EGHP, used only when an EGHP accounts receivable has been satisfied (RG type AR). This status is for display purposes only, internally the claim status would be a ‘y’.
Partial refund applied, partial refund was calculated for the claim but was applied to something else outstanding, such as an AR.
Claim still active. This is an internal MCS MPAP status, and will never display online.
Claim in pending suspense, used as history for duplicate audits but not MPAP (relationship or negative relationship audit). This is an internal MCS MPAP status, and does not display online except as related history or on a bene research document (BRD). The status can be set several ways: * claim has no significant claim-level audit failed, but has claim-level edit suspense (does not look at history usage on edit) * claim or detail suspends for a post-CWF audit * detail suspends with ‘f’ disposition audit that has a history usage of ‘3’
CWF suspense, no MPAP, the HIC change trailer on the claim has a different cross-reference HIC than the ‘h’ trailer on eligibility. Note: the ‘L’ status is an internal status and will not appear on a claim. While the HIC is being changed, the claim will have an ‘L’ status until the change is complete.
Approved and paid (includes all deductible) - currently not used.
Denied for payment (excludes deductible), set based on the history usage (AA segment) indicator on a denial edit or audit.
Partial claim refund - EGHP, used only when an EGHP accounts receivable has been satisfied (RG type AR). This status is for display purposes only, internally the claim status would be a ‘g’.
Adjusted - claim has been replaced by a full claim adjustment.
Claim has been deleted from the system. When a claim is deleted (transferred to location 090), the claim status and the detail status are both set to ‘R’.
Paid but not for dup use - currently not used.
Denied, but not for dup use, set based on the history usage indicator on the AA segment of a denial edit or audit.
Rejected. This status is set for Assigned and Non-Assigned claims, based on the receipt date, the bene submission form, and the reject indicator which is MSG ACTION = RJ or R2 on the Narrative Message Usage file (NA). If all details are rejected (status ‘W’) then the claim status is set to rejected (‘W’). Unassigned details with receipt dates prior to July 1, 2005 that have incomplete or invalid information will be denied, not rejected.
Partial refund, claim that is a partial void and a split pay.
Full refund, full amount of claim payment was returned.
Voided, full void has been issued for the claim.
Current active claim, separate history. This is an internal MCS MPAP status, and will only display online in related history. This status applies to the header of claims that contain a demonstration number that has been flagged for separate history in the HXXTDEMO table.
Suspended, separate history. All pending claims will show this status when they are viewed online. All other pending claim statuses are used internally by MCS MPAP only. This status applies to the header of claims that contain a demonstration number that has been flagged for separate history in the HXXTDEMO table.
Approved awaiting CWF response, separate history, through MPAP, claim processed with no outstanding edits/audits through MPAP and queried. This status applies to the header of claims that contain a demonstration number that has been flagged for separate history in the HXXTDEMO table.
Approved and paid, separate history. This status applies to the header of claims that contain a demonstration number that has been flagged for separate history in the HXXTDEMO table.
Denied; separate history, set based on the history usage indicator on the AA segment of a denial edit or audit. This status applies to the header of claims that contain a demonstration number that has been flagged for separate history in the HXXTDEMO table.
Not Used.
Claim moved to another HIC. Claim was submitted and finalized for a HIC prior to the HIC being changed. (This status is internal to MCS only and will not display online.)
Claim deleted from system. Claim deleted from MPAP due to rework, the ICN is a duplicate of another ICN in the system. (This status is internal to MCS only and will not display online.)
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