Claim Status Category Code and Claim Status Code Update

Claim status information is available via our Automated Response Unit (ARU), Direct Data Entry (DDE) Online System for Part A or eServices for Part A and B. All payers must use the health care claims status category codes and health care claim status codes approved by the Health Care Code Maintenance Committee.

The claim category and claim status codes explain the status of submitted claims. The Health Insurance Portability and Accountability Act (HIPAA) requires all health care benefit payers to use only national Code Maintenance Committee-approved codes in the X12 276/277 Health Care Claim Status Request and Response format adopted as the standard for national use (004010X093A1).

The national Code Maintenance Committee meets at the beginning of each X12 trimester meeting (February, June and October) to decide about additions, modifications and retirement of existing codes. Included in the code lists are specific details, including the date when a code was added, changed or deleted. The code changes for claim status category codes and claim status codes are posted to the Washington Publishing Company (WPC) website. Please visit the WPC website for a complete list of these codes.