Module 1, Topic 1
In Progress

Day 1: Claim Status Request and Response

Petria September 3, 2020

Claim Status Request and Response

Providers have a number of options to obtain claim status information from Medicare Administrative Contractors (MACs):

  • Providers can enter data via the Interactive Voice Response (IVR) telephone systems operated by the MACs.
  • Providers can submit claim status inquiries via the Medicare Administrative Contractors’ provider Internet-based portals.
  • Some providers can enter claim status queries via direct data entry screens.

 

 

Interactive Voice Response (IVR) Information

Home Health and Hospice (HHH) providers may use the Interactive Voice Response (IVR) to request routine claims, beneficiary eligibility and payment information. The IVR is available 24 hours a day to obtain general information.  With a touch-tone phone, you can obtain the latest information on your claims and other Medicare issues.

TIP: Using a speakerphone when in the IVR can interfere with using the various functions. Please place your phone on mute to ensure no background noise interferes with your call. Please see the following links for more guidance about the HHH IVR:

  • Flow Chart
  • IVR Conversion Tool: This tool will assist you in entering the Provider Transaction Account Number (PTAN) and the Patient’s Medicare number and name. Be sure to write down the conversion numbers before calling the IVR.  Keep it prominent for future IVR calls.
  • As an alternative to the IVR, I still suggest using your MAC portals , a free Internet-based, provider self-service portal. Again, you can use the portals for access to information on beneficiary eligibility, claim status, duplicate remittance notices, amounts of the last three checks issued to a provider, the amount approved to pay (on the payment floor) and many other helpful features.
  • All claims will temporarily suspend in different S/LOCs as they process through FISS.

 

 

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.

LOCATION CODE