Claims Inquiry Search (Advanced Tab) Page

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You use the Claims Inquiry Search Advanced tab to search for claims using claim, provider, member, and other information.

The Advanced tab of the Claims Inquiry Search page contains the following panels:

Advanced Search Fields

Field	Description
Provider Data Fields Provider or Member must be specified. You may use both.
Provider Role	Indicates whether the search criteria are for the billing or rendering provider information.
Provider ID Type Code	The type of provider ID. Examples: Medicaid, National Provider ID (NPI)
Provider ID	Unique identifier used for a provider of healthcare services. Format: Up to 15 alphanumeric characters
Member Data Fields
Member ID	A unique identifier assigned to a member
Date of Service Fields These fields allow you to search for claims with dates of service within the range specified. One date range (Date of Service, Adjudication Date, or Paid Date) is required. You may use more than one.
Begin	The first date of service in the date range you are searching. Format: MM/DD/YYYY
End	The last date of service in the date range you are searching. Format: MM/DD/YYYY
Adjudication Date Fields These fields allow you to search for claims with adjudication dates (date the claim was processed by ND MMIS) within the range specified. One date range (Date of Service, Adjudication Date, or Paid Date) is required. You may use more than one.
Begin	Indicates the first adjudication date in the date range you are searching. Format: MM/DD/YYYY
End	Indicates the last adjudication date in the date range you are searching. Format: MM/DD/YYYY
Paid Date Fields These fields allow you to search for claims with payment dates within the range specified. One date range (Date of Service, Adjudication Date, or Paid Date) is required. You may use more than one.
Begin	The first paid date in the date range you are searching. Format: MM/DD/YYYY
End	The last paid date in the date range you are searching. Format: MM/DD/YYYY
Additional Search Criteria Fields In addition to Provider or Member information and a date range, you can narrow your search by completing any of the additional fields.
Include Status (Paid, Denied, Suspended, To Be Paid , To Be Denied)	Indicates the status of the claim. Examples: Paid, To Be Paid, Denied, To Be Denied Claims with the status selected are included in the search.
Federal Tax ID	A tax identification number used to identify a business. Similar to a Social Security number, which is used to identify an individual. When the provider role is a rendering provider, this field cannot be used.
Remittance Advice	The sequential number of the remittance advice statement for the claim.
Service Auth ID	Service Authorization ID. A unique ID assigned to the service authorization.
LOB	The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid.
Benefit Plan ID	Unique identifier for the benefit plan.
Category of Service	The services for which enrolled providers are authorized to bill.
Claim Type	Identifies, at a high level, the type of claims processed in the batch. Examples: Institutional (UB04), Institution Crossover, Void
Trans Type	Indicates the transaction type of the claim. Examples: Original Claim, Void
Provider Type	The provider classification. Based on the Level I Provider Type of the Taxonomy Code Set. Examples: Dental, Pharmacy, Hospital, Vision, Physician
Diagnosis Code	A standard code used to describe the nature of a patient's illness or injury.
DRG Code	Diagnosis Related Group code.
Fund Code	The budget and funding sources applicable to a claim.
Fiscal Pend	Indicates the condition for which the claim was pended.
Procedure Code Fields Allows you to search for claims with procedure codes that are within the range of codes specified.
From	The first procedure code in a range of procedures codes to search.
Modifier (1-4)	A two-digit code attached to the procedure code to modify or clarify the description of the procedure. Up to four modifiers may be submitted on a claim for each procedure code, if applicable.
To	The last procedure code in a range.
Modifier (1-4)	A two-digit code attached to the procedure code to modify or clarify the description of the procedure. Up to four modifiers may be submitted on a claim for each procedure code, if applicable.
Revenue Code Fields Allows you to search for claims with revenue codes that are within the range of revenue codes specified.
From	The first revenue code the range of revenue codes to search.
To	The last revenue code the range of revenue codes to search.
Billed Amount Fields Allows you to search for claims with billed amounts that are within the range of billed amounts specified.
From	The first billed amount in the range of billed amounts to search. If the amount includes cents, you must enter the decimal point.
To	The last billed amount in the range of billed amounts to search. If the amount includes cents, you must enter the decimal point.
Reimbursement Amount Fields Allows you to search for claims with reimbursement amounts that are within the range of reimbursement amounts specified.
From	The first reimbursement amount in the range of reimbursement amounts to search. If the amount includes cents, you must enter the decimal point.
To	The last reimbursement amount in a range of reimbursement amounts to search. If the amount includes cents, you must enter the decimal point.
Allowed Amount Fields Allows you to search for claims with allowed amounts that are within the range of allowed amounts specified.
From	The first allowed amount in a range of allowed amounts to search. If the amount includes cents, you must enter the decimal point.
To	The last allowed amount in a range of allowed amounts to search. If the amount includes cents, you must enter the decimal point.

Field

Description

Provider Data Fields

Provider or Member must be specified. You may use both.

Provider Role

Indicates whether the search criteria are for the billing or rendering provider information.

Provider ID Type Code

The type of provider ID.

Examples: Medicaid, National Provider ID (NPI)

Provider ID

Unique identifier used for a provider of healthcare services.

Format: Up to 15 alphanumeric characters

Member Data Fields

Member ID

A unique identifier assigned to a member

Date of Service Fields

These fields allow you to search for claims with dates of service within the range specified. One date range (Date of Service, Adjudication Date, or Paid Date) is required. You may use more than one.

Begin

The first date of service in the date range you are searching.

Format: MM/DD/YYYY

End

The last date of service in the date range you are searching.

Format: MM/DD/YYYY

Adjudication Date Fields

These fields allow you to search for claims with adjudication dates (date the claim was processed by ND MMIS) within the range specified. One date range (Date of Service, Adjudication Date, or Paid Date) is required. You may use more than one.

Begin

Indicates the first adjudication date in the date range you are searching.

Format: MM/DD/YYYY

End

Indicates the last adjudication date in the date range you are searching.

Format: MM/DD/YYYY

Paid Date Fields

These fields allow you to search for claims with payment dates within the range specified. One date range (Date of Service, Adjudication Date, or Paid Date) is required. You may use more than one.

Begin

The first paid date in the date range you are searching.

Format: MM/DD/YYYY

End

The last paid date in the date range you are searching.

Format: MM/DD/YYYY

Additional Search Criteria Fields

In addition to Provider or Member information and a date range, you can narrow your search by completing any of the additional fields.

Include Status (Paid, Denied, Suspended, To Be Paid , To Be Denied)

Indicates the status of the claim.

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

Claims with the status selected are included in the search.

Federal Tax ID

A tax identification number used to identify a business. Similar to a Social Security number, which is used to identify an individual.

When the provider role is a rendering provider, this field cannot be used.

Remittance Advice

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

Service Auth ID

Service Authorization ID. A unique ID assigned to the service authorization.

LOB

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

Benefit Plan ID

Unique identifier for the benefit plan.

Category of Service

The services for which enrolled providers are authorized to bill.

Claim Type

Identifies, at a high level, the type of claims processed in the batch.

Examples: Institutional (UB04), Institution Crossover, Void

Trans Type

Indicates the transaction type of the claim.

Examples: Original Claim, Void

Provider Type

The provider classification. Based on the Level I Provider Type of the Taxonomy Code Set.

Examples: Dental, Pharmacy, Hospital, Vision, Physician

Diagnosis Code

A standard code used to describe the nature of a patient's illness or injury.

DRG Code

Diagnosis Related Group code.

Fund Code

The budget and funding sources applicable to a claim.

Fiscal Pend

Indicates the condition for which the claim was pended.

Procedure Code Fields

Allows you to search for claims with procedure codes that are within the range of codes specified.

From

The first procedure code in a range of procedures codes to search.

Modifier (1-4)

A two-digit code attached to the procedure code to modify or clarify the description of the procedure. Up to four modifiers may be submitted on a claim for each procedure code, if applicable.

The last procedure code in a range.

Modifier (1-4)

A two-digit code attached to the procedure code to modify or clarify the description of the procedure. Up to four modifiers may be submitted on a claim for each procedure code, if applicable.

Revenue Code Fields

Allows you to search for claims with revenue codes that are within the range of revenue codes specified.

From

The first revenue code the range of revenue codes to search.

The last revenue code the range of revenue codes to search.

Billed Amount Fields

Allows you to search for claims with billed amounts that are within the range of billed amounts specified.

From

The first billed amount in the range of billed amounts to search.