Financial Claim Detail Page

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You use the Financial Claim Detail page of Claims Inquiry to view a claim in ND MMIS.

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Claim Data Fields

Field	Description
Doc #	Document Number. Identifies the claim as it is sequenced within a batch.
FT/TCN	The transaction control number (TCN) is a unique number assigned by the ND MMIS to each claim.
Claim Type	The type of claim. Examples: Inpatient, Outpatient, Financial Transaction
Status	Indicates the status of the claim. Examples: Paid, To Be Paid, Denied, To Be Denied
LOB	The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid.
Doc Type	Document Type. Indicates the type of document. Examples: Adjustment Claims, FFS Provider Payment, Encounter Claims
Pay Type	Indicates the payment type of the claim. Examples: For Payment, History Only
Trans Type	Transaction Type. Indicates the transaction type of the claim. Examples: Original Claim, Void
Location	The location of a suspended claim.
Adjud Date / Time	Adjudication Date / Time. The date and time the claim was last adjudicated.
DOS Begin	Date of Service Begin. The first date of service.
DOS End	Date of Service End. The last date of service.
Fiscal Pend ID	Indicates the condition for which the claim was pended.
Fiscal Pend Indicator	Indicates whether the claim is currently in a pend status.
Org Fiscal Pend Date	The date that the claim was first placed into fiscal pend status.
Adjud Date/Time	Adjudication Date / Time. The date and time the claim was last adjudicated.
User ID	Indicates the user who last adjudicated the claim.
Reported Adjud Date	???

Field

Description

Doc #

Document Number.

Identifies the claim as it is sequenced within a batch.

FT/TCN

The transaction control number (TCN) is a unique number assigned by the ND MMIS to each claim.

Claim Type

The type of claim.

Examples: Inpatient, Outpatient, Financial Transaction

Status

Indicates the status of the claim.

Examples: Paid, To Be Paid, Denied, To Be Denied

LOB

The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid.

Doc Type

Document Type.

Indicates the type of document.

Examples: Adjustment Claims, FFS Provider Payment, Encounter Claims

Pay Type

Indicates the payment type of the claim.

Examples: For Payment, History Only

Trans Type

Transaction Type.

Indicates the transaction type of the claim.

Examples: Original Claim, Void

Location

The location of a suspended claim.

Adjud Date / Time

Adjudication Date / Time. The date and time the claim was last adjudicated.

DOS Begin

Date of Service Begin. The first date of service.

DOS End

Date of Service End. The last date of service.

Fiscal Pend ID

Indicates the condition for which the claim was pended.

Fiscal Pend Indicator

Indicates whether the claim is currently in a pend status.

Org Fiscal Pend Date

The date that the claim was first placed into fiscal pend status.

Adjud Date/Time

Adjudication Date / Time. The date and time the claim was last adjudicated.

User ID

Indicates the user who last adjudicated the claim.

Reported Adjud Date

???

Member Fields

Field	Description
These fields provide information about the member for whom this financial claim was established.
Member ID	A unique identifier assigned to a member. Links to the Member Summary page for the member, if you have access.
Name	The member's full name
COE Code-Desc	Category of Eligibility. Indicates the basis for the member's eligibility for Medicaid. To be eligible for Medicaid benefits, a member must meet the eligibility requirements for one or more specifically defined coverage groups.

Field

Description

These fields provide information about the member for whom this financial claim was established.

Member ID

A unique identifier assigned to a member.

Links to the Member Summary page for the member, if you have access.

Name

The member's full name

COE Code-Desc

Category of Eligibility.

Indicates the basis for the member's eligibility for Medicaid. To be eligible for Medicaid benefits, a member must meet the eligibility requirements for one or more specifically defined coverage groups.

Related Financial Fields

Field	Description
FCN	The financial control number (FCN) assigned to the financial document. The FCN consists of the date it was created, the media source (how it was received), and a document number. Format: YYYYMMDDMNNNNN
Reason Code	Indicates the reason for the financial control transaction.
Category of Svc	Category of Service. The services for which enrolled providers are authorized to bill.
Fund Code	The budget and funding sources applicable to a claim.
Related TCN	The transaction control number (TCN) is a unique number assigned by the ND MMIS to each claim.

Field

Description

FCN

The financial control number (FCN) assigned to the financial document. The FCN consists of the date it was created, the media source (how it was received), and a document number.

Format: YYYYMMDDMNNNNN

Reason Code

Indicates the reason for the financial control transaction.

Category of Svc

Category of Service.

The services for which enrolled providers are authorized to bill.

Fund Code

The budget and funding sources applicable to a claim.

Related TCN

The transaction control number (TCN) is a unique number assigned by the ND MMIS to each claim.

Payee/Payer Fields

Field	Description
Payee/Payer Type	The type of external payee/payer. Examples: Member, Provider, TPL
Payee/Payer ID Type Code	The type of ID indicated for the payee/payer.
Payee/Payer ID	The external ID of the payee/payer. Links to the Financial Accounting Entity page in the Financial Accounting Entity function for more details.
Name	The payee/payer name.
Tax ID/SSN	The payee/payer tax ID or Social Security number.

Field

Description

Payee/Payer Type

The type of external payee/payer.

Examples: Member, Provider, TPL

Payee/Payer ID Type Code

The type of ID indicated for the payee/payer.

Payee/Payer ID

The external ID of the payee/payer.

Links to the Financial Accounting Entity page in the Financial Accounting Entity function for more details.

Name

The payee/payer name.

Tax ID/SSN

The payee/payer tax ID or Social Security number.

Payment Fields

Field	Description
Paid Date	Indicates the date the claim was paid.
Reimb Amt	Reimbursement Amount. The amount paid.
R/A #	The sequential number of the remittance advice statement for the claim.
EFT/Check #	The unique check or electronic funds transfer number assigned to the payment transaction.
Internal Warrant #	Uniquely identifies a payment to a provider for a given payment cycle.
Fed Amt	The Federal fund amount applied to the claim.
St Amt	The State fund amount applied to the claim.
Cnty Amt	The County fund amount applied to the claim.
Other Amt	The Other fund amount applied to the claim.
Base Rate Changes Fields Base rate changes are changes to the allowed charge. These occur in pricing and final adjudication. Examples are service authorization cutbacks, spenddown, and TPL.
Amount	The amount of the base rate change.
Description	The description of the base rate change.

Field

Description

Paid Date

Indicates the date the claim was paid.

Reimb Amt

Reimbursement Amount. The amount paid.

R/A #

The sequential number of the remittance advice statement for the claim.

EFT/Check #

The unique check or electronic funds transfer number assigned to the payment transaction.

Internal Warrant #

Uniquely identifies a payment to a provider for a given payment cycle.

Fed Amt

The Federal fund amount applied to the claim.

St Amt

The State fund amount applied to the claim.

Cnty Amt

The County fund amount applied to the claim.

Other Amt

The Other fund amount applied to the claim.

Base Rate Changes Fields

Base rate changes are changes to the allowed charge. These occur in pricing and final adjudication. Examples are service authorization cutbacks, spenddown, and TPL.

Amount

The amount of the base rate change.

Description

The description of the base rate change.