Overview
Claim Status Checks saves time by creating electronic inquiries against payer adjudication systems to verify status of submitted claims. Several claim demographic points are required to get this initiated:
Payer — the payer name adjudicating the claim
Patient First Name — the patient's first name on the submitted claim
Patient Last Name — the patient's last name on the submitted claim
Patient Date of Birth — the patient's date of birth on the submitted claim
Patient Subscriber ID — the insurance member or subscriber ID associated with the patient on the submitted claim
Date of Service — the service date(s) associated with the specific encounter
Accessing Claim Status Checks from Labs
Open Labs from the top-right corner of the Rivet portal.
Click the +New button to initiate a new request
Input required fields from the claim status check to initiate the process
The claim status check history will be available in a table format with key data elements:
Claim number — the payer's claim number associated with the submitted claim
Payer — the payer and payer ID submitted on the 276
Patient — the patient's demographic data submitted on the 276
DOS — the service date(s) from the 276 which should correspond to the claim
Status — the submission status from the payer connection on either a failed or completed run
Result — the raw data including claim status code and claim status category code indicating the summarized values returned on the payer's 277
Checked — the date that the 276 claims status check was submitted
Helpful tips
The standard library of claim status codes and claim status category codes are used when referencing payer 277 responses. These are provided as part of the raw data response and industry standard resources are linked below:
Claim Status Codes: https://x12.org/codes/claim-status-codes
Claim Status Category Codes: https://x12.org/codes/claim-status-category-codes