Find-A-Code Focus Newsletter

Be Proactive - Check Your Claim Status

By Wyn Staheli
November 30, 2015

We've been using ICD-10-CM for a few weeks now. If you haven't already started getting EOBs from your payers, get proactive and start checking claim status on your own. You may have been coding correctly to begin with, but there can be some hiccups between claim submission and adjudication. For example, we've heard from providers who've told us that their computer software dropped the final character of the ICD-10-CM code when their claims were submitted.

Don't assume that the payer will get it right or got it right to begin with. The bottom line is that you need to start checking right away. The following information is from Medicare (other payers may vary):

You can check your claim status by:

  • Interactive Voice Response (IVR): IVR gives providers access to Medicare claims information through a toll-free telephone number. Visit your Medicare Administrative Contractor (MAC) website for information on the Provider Contact Center and IVR user guide.
  • Customer Service Representative (CSR): Visit your MAC website for information on the Provider Contact Center only if you are unable to access claims information via IVR.
  • MAC portal: Visit your MAC website for portal features and access.
  • Direct Data Entry (DDE): Providers that bill institutional claims are also permitted to submit claims electronically via DDE screens. Visit your MAC website for more information.
  • ASC X12: The ASC X12 Health Care Claim Status Request and Response (276/277) is a pair of electronic transactions you can use to request the status of claims (via the 276) and receive a response (via the 277). Visit your MAC website for more information.

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