You use the Professional Claim Detail page of Claims Inquiry to view a claim in ND MMIS.
The Adjustments/History tab contains the following panels:
| Field | Description |
|---|---|
| Doc # |
Document Number. Identifies the claim as it is sequenced within a batch. |
| 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. |
| Replaced TCN |
The TCN of the claim that is replaced. Links to the Claims Inquiry page for the claim associated with the control number, if you have access. |
| Replacement Reason |
Indicates the reason for replacing or voiding the claim. |
| Replacement TCN |
The TCN of the replacement claim. Used when adjusting a previously adjudicated claim. Links to the Claims Inquiry page for the claim associated with the control number, if you have access. |
| Submitted Void/Replace TCN | ??? |
|
External TCN |
A TCN assigned to the claim by a system other than the ND MMIS. |
| X12 Version Number | ??? |
| 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. |
| Field | Description |
|---|---|
| Line |
The line item number to which the exception code is related. Links to the Line Item Detail for this claim. |
| Exception |
The exception code. Exceptions are posted to a claim when edits, which are business rules defined by North Dakota to manage claim processing, evaluate the claim data, and find discrepancies. These may include the absence of required data or the presence of invalid data. |
| History TCN |
The transaction control number (TCN) in history. Links to the Claims Inquiry page for the claim associated with the TCN, if you have access. |
| History Line |
The line number in history. |
| Claim Type |
The type of claim. Examples: Inpatient, Outpatient, Financial Transaction |
| Paid Date | The date the claim was paid. |
| Field | Description |
|---|---|
| TCN |
The transaction control number (TCN) of the claim that replaces or voids a previously submitted claim. Links to the Claims Inquiry page for the claim associated with the control number, if you have access. |
| Reason |
Indicates the reason for replacing or voiding the claim. |
| Field | Description |
|---|---|
| Code | The location of a suspended claim. |
| Routed to User ID | The ID and name of the user to whom the claim routed. |
| Exception | The exception code. Exceptions are posted to a claim when edits, which are business rules defined by North Dakota to manage claim processing, evaluate the claim data, and find discrepancies. These may include the absence of required data or the presence of invalid data. |
| Date | The date the claim was routed. |
| Routed By User ID | The ID and name of the user who routed the claim. |
Version as of 5/16/14.
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