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The Claim History page lists the transaction history for the selected claim. Each row represents a separate transaction associated with the claim identified by the following criteria:
Table 1: Claim Information
| Field | Description |
|---|---|
| Claim Number | Claim number assigned by the RRE/Insurer. |
| Beneficiary Name | Name matched in the Beneficiary database associated with this claim. |
| Medicare ID | Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI) associated with this claim. Note: This is also known as the Medicare Number to CMS’ Medicare beneficiaries. |
| CMS Date of Injury | DOI as defined by CMS associated with this claim. |
| Industry Date of Injury | DOI used by insurance/workers' compensation industry associated with this claim. |
Table 2: Transaction Information
| Field | Description |
|---|---|
| DCN | Document Control Number assigned to this transaction. |
| Transaction Date | Date this transaction was last updated. |
| Action | Transaction type processed/requested for the claim. Values are Add, Update, or Delete. |
| Status | Current status of this transaction. Values include Saved Not Submitted, New, In Process, Error, Completed, or Deleted. |
| Disposition | Disposition of this transaction. Values are: 01 - Record accepted, applied at CWF 02 - Record accepted, no ORM reported 03 - Record accepted, but coverage period does not overlap with the injured party’s entitlement period SP - Record received processing errors. Refer to the S111 NGHP User Guide on the CMS website for more information about errors. Note: Processing errors will appear at the top of the Claim Information page. |
Click Claim Listing or RRE Information to return to their respective pages.
September 2024
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