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Jurisdiction 11 Home Health and Hospice
Claim Status and Location Hints and Tips

Understanding exactly where claims are located in the system is the key to determining what action, if any, can be taken by providers who submit claims on the UB-04 claim form. All claims submitted on the UB-04 claim form are processed in the Fiscal Intermediary Shared System (FISS). Providers may view the status and location (S/LOC) of their claims using the Online Provider Services (OPS) or Direct Data Entry (DDE) systems. Providers are encouraged to monitor the status and location of their claims. Page three of the DDE Manual provides a detailed description of status and location code components. The information below highlights the different statuses and locations in which claims are placed.

The six statuses in the FISS system include:

'S' Status (Suspended)
The claim is still in process and no provider intervention can be made.

  • All incoming claims first go to the 'S' status
  • Claims cycling in the Common Working File (CWF)
  • Claims chosen for medical review

When a claim is in 'S' status, providers should wait for the claim to move to a completed status. Providers should not send another claim, and should monitor how long a claim is in this status. If a claim is in the same 'S' status and location for a period of longer than 30 days, providers may call the designated Provider Contact Center (PCC) to request that the claim be released and processed.

'P' Status (Paid/Processed)
The claim is completely processed and is either fully or partially paid.

'D' Status (Denied)
The claim is completely processed and denied by Medical Review.

  • Providers can not adjust or cancel the claim
  • The provider can submit an appeal/redetermination

'R' Status (Rejected)
The claim is completely processed and was rejected.

  • Look at the reason code on the rejected claim and resubmit a new claim with corrections noted from the reason code narrative, if applicable
  • Adjust the claim if it posted to the CWF and make the necessary corrections. Providers can determine if the claim was posted to the CWF by viewing the TPE-TO-TPE field in the system. If this field contains an 'X', the finalized claim was not posted to CWF.

'T' Status (Return to Provider)
The claim has been returned to the provider (RTPd) for correction.

  • Review the reason code on the claim, make the necessary corrections and resubmit the claim
  • Do not submit a new claim

'I' Status (Inactive)
The Medicare Administrative Contractor (MAC) has either inactivated or specially processed your claim.

  • RTPs more than 60 days old and suppressed claims are moved to an 'I B9997' status for three years then purged
  • A new claim may be submitted

The charts below reflect some of the most common status and locations.

Status
Description
P B9996 Payment Floor
P B9997
Paid/Processed Claim
P B7501
Post-Pay Review
P B7505
Post-Pay Review
R B9997
Claims Processing Rejection
  • Provider must either resubmit the claim or adjust it. See the job aid titled 'Determining Whether to Resubmit, Adjust or Appeal a Medicare Claim'.
DB9997
Medical Review Denial
T B9900
Daily Return to Provider (RTP) Claim
  • The claim is not yet accessible for the provider to correct.
T B9997
RTP Claim
  • The claim may be accessed and corrected through the Claim and Attachments Corrections Menu (Main Menu Option 03) in DDE.

Providers should note that no intervention can be made on claims in a 'S' status and location.

Status
Description
S B0100
Claim is beginning the FISS batch process
S B6000
Claim is awaiting the creation of an Additional Documentation Request (ADR) letter
S B6001
Claims awaiting a provider response to an ADR letter.
Do not press F9 on these claims because FISS will generate another ADR.
S B9000
Claim is ready to go to a CWF host site
S B9099
Claim is awaiting a response from a CWF host site
S Mxxx
Suspended claims/adjustments requiring Palmetto GBA staff intervention (the 'x' denotes a variety of FISS location codes)


 

last updated on 07/05/2013
ver 1.0.43