Claim Status
claim status 270-271
/medicalnetwork/claimstatus/v2/claimstatus
Check Claim Status
Header Parameters
| Name | Type | Description |
|---|---|---|
| Authorization* | string | Bearer Your-Access-Token<br/>Example: <b>Bearer eyJraWQiOiIxIiwid…</b> |
Request Body*
application/json
Header, Segment: ST02 (no loop), Notes: Transaction Set Control Number
Loop: 2100A, Segment: NM1, Element: NM103, Notes: organizational name
Loop: 2100A Segment: NM1, Element: NM109, Notes: we send this as MN108 as PI = Payer Identification
Loop: 2100B, Loop: 2100C
Loop: 2000D
Loop: 2100D, Segment: NM1, Element: NM109, Notes: The subscriber's insurance member ID. Maps to subscriberId.
Loop: 2100D, Segment: NM1, Element: NM104, Notes: The subscriber's first name as specified on their policy
Loop: 2100D, Segment: NM1, Element: NM103, Notes: The subscriber's last name as specified on their policy.
Loop: 2000D, 2000E, Segment: DMG, Element: DMG03, Notes: The subscriber's gender as specified on their policy.
Enum: MFU
Loop: 2000D, Segment: DMG, Element: DMG02, Notes: The birth date as specified on the policy for the subscriber. Maps to BirthDate
Loop: 2200D, Segment: REF, Element: REF01, Notes: The group number associated with the subscriber.
Loop: 2000E
Loop: 2100E, Segment: NM1, Element: NM104, Notes: The dependent's first name as specified on their policy.
Loop: 2100E, Segment: NM1, Element: NM103, Notes: The dependent's last name as specified on their policy.
Loop: 2000E, Segment: DMG, Element: DMG03, Notes: dependent's gender as specified on their policy.
Enum: MFU
Loop: 2000E, Segment: DMG, Element: DMG02, Notes: The birth date as specified on the policy for the dependent.
Loop: 2200E, Segment: REF, Element: REF02 when REF01=6P, Notes: The group number associated with the subscriber and dependent. Maps to dependent groupNumber.
Loop: 2200D or 2200E
Loop: 2200D or 2200E, Segment: DTP, Element: DTP03, Notes: Date Time Period - Start Date
Loop: 2200D or 2200E, Segment: DTP, Element: DTP03, Notes: Date Time Period - End Date
Loop: 2200D or 2200E, Segment: TRN, Element: TRN02, Notes: This is the claim status tracking number assigned to the status query for the claim.
Loop: 2200D or 2200E, Segment: REF, Element: REF02, Notes: This is the payer assigned claim number. descriptions goes in REF02 where REF01=1K
Loop: 2200D or 2200E, Segment: REF, Element: REF02, Notes: Required if application or location system identifier is known. descriptions goes in REF02 where REF01=LU
Loop: 2200D or 2200E, Segment: REF, Element: REF02, Notes: Billing type reference ID. Example: billing type for inpatient services is 111. descriptions goes in REF02 where REF01=BLT
Loop: 2200D or 2200E, Segment: REF, Element: REF02, Notes: Patient account number provided by service provider. description goes in REF02 where REF01=EJ
Loop: 2200D or 2200E, Segment: REF, Element: REF02, Notes: Patient pharmacy prescription number. description goes in REF02 where REF01=XZ
Loop: 2200D or 2200E, Segment: REF, Element: REF02, Notes: Claim number provided by clearing house. description goes in REF02 where REF01=D9
Loop: 2200D or 2200E, Segment: AMT, Element: AMT02, Notes: Submitted total charges. description goes in AMT02 where AMT01=T3
Loop: 2220D or 2220E
Loop: 2210D, 2210E, Segment: SVC, Element: SVC01-1, Notes: Allowed Values are 'AD' American Dental Association Codes, 'ER' Jurisdiction Specific Procedure and Supply Codes, 'HC' Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, 'HP' Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code, 'IV' Home Infusion EDI Coalition (HIEC) Product/Service Code, 'N4' National Drug Code in 5-4-2 Format, 'NU' National Uniform Billing Committee (NUBC) UB92 Codes, 'WK' Advanced Billing Concepts (ABC) Codes
Enum: ADERHCHPIVN4NUWK
Loop: 2210D, 2210E, Segment: SVC, Element: SVC01-2, Notes: Procedure Code maps to Product/ServiceID
Loop: 2210D, 2210E, Segment: SVC, Element: SVC01-3 to SVC01-6, Notes: Procedure Modifier
Loop: 2210D, 2210E, Segment: SVC, Element: SVC02, Notes: Maps to Monetary Amount, This amount is the original submitted charge.
Loop: 2210D, 2210E, Segment: SVC, Element: SVC04, Notes: Identifying number for a product or service
Loop: 2210D, 2210E, Segment: SVC, Element: SVC07, Notes: Maps to Quantity, Numeric value of quantity accepted
Loop: 2210D, 2210E, Segment: REF, Element: REF02 when REF01 = FJ, Notes: Maps to Reference Identification
Loop: 2210D, 2210E, Segment: DTP, Element: DTP03, Notes: When sent with serviceLineEndDate it will be used as the start date for Date Time period, if sent without serviceLineEndDate will use DTP02 = D8
Loop: 2210D, 2210E, Segment: DTP, Element: DTP03, Notes: DTP03 enddate and DTP02=RD8
Responses
Response
Provided by the submitter in the 270 Request. Transaction Set Control Number.
ID used by Clearing House for the trading partner.
Loop: 2100A
Segment: NM1, Element: NM103, Notes: Payers’s organization name.
Segment: NM1, Element: NM109, Notes: Payers’s identification number established through trading partner agreement. NM108=PI
Segment: NM1, Element: NM109, Notes: Use when reporting Health Plan ID (HPID) or Other Entity Identifier (OEID). NM108=XV
Segment: PER
Segment: PER, Element: PER02, Notes: Payer’s name.
Segment: PER, Element: PER04, PER06 or PER08, Notes: Payer's electronic data interchange access number. PER03=PER05=PER07=ED
Segment: PER, Element: PER04, PER06 or PER08, Notes: Payer's email. PER03=PER05=PER07=EM
Segment: PER, Element: PER04, PER06 or PER08, Notes: Payer's facsimile number. PER03=PER05=PER07=FX
Segment: PER, Element: PER04, PER06 or PER08, Notes: Payer's telephone number. PER03=PER05=PER07=TE
Segment: PER, Element: PER04, PER06 or PER08, Notes: Payer's telephone extension. PER05=PER07=EX
Loop: 2100B and 2100C
Loop: 2000D
Loop: 2100D, Segment: NM1, Element: NM109, Notes: The subscriber's insurance member ID. Maps to subscriberId.
Loop: 2100D, Segment: NM1, Element: NM104, Notes: The subscriber's first name as specified on their policy
Loop: 2100D, Segment: NM1, Element: NM103, Notes: The subscriber's last name as specified on their policy.
Loop: 2000D, 2000E, Segment: DMG, Element: DMG03, Notes: The subscriber's gender as specified on their policy.
Enum: MFU
Loop: 2000D, Segment: DMG, Element: DMG02, Notes: The birth date as specified on the policy for the subscriber. Maps to BirthDate
Loop: 2200D, Segment: REF, Element: REF01, Notes: The group number associated with the subscriber.
Loop: 2000E
Loop: 2100E, Segment: NM1, Element: NM104, Notes: The dependent's first name as specified on their policy.
Loop: 2100E, Segment: NM1, Element: NM103, Notes: The dependent's last name as specified on their policy.
Loop: 2000E, Segment: DMG, Element: DMG03, Notes: dependent's gender as specified on their policy.
Enum: MFU
Loop: 2000E, Segment: DMG, Element: DMG02, Notes: The birth date as specified on the policy for the dependent.
Loop: 2200E, Segment: REF, Element: REF02 when REF01=6P, Notes: The group number associated with the subscriber and dependent. Maps to dependent groupNumber.
Loop: 2200D and 2200E
Segment: ISA, Element: ISA13, Notes: Interchange control number
Code for the error.
Description of the error code. Value provided in payer id should be a valid Optum assigned ERA payer Id.
The number assigned by the originator to identify the transaction within the originator's business application system
The number assigned by the originator to identify the transaction within the originator's business application system
Loop: 2200D, Segment: STC, Element: STC01, Health care claim status, Used to convey status of the entire claim or specific service line.
The 999 acknowledgment code
The 999 syntax error code
Basic x12 edi response (for x12 endpoint)
Meta data about the request
submitterId assigned to this request
senderId assigned to this request
billerId assigned to this request
Unique Id assigned to each request by Optum
Used by Optum to identify where this request can be found for support
Example Request
curl -X POST \ 'https://sandbox-apigw.optum.com/medicalnetwork/claimstatus/v2/'