hippo 0.0.10 → 0.0.11

data/lib/hippo/code_lists/claim_status_category_codes.rb

@@ -0,0 +1,376 @@
+module Hippo::CodeLists
+  class ClaimStatusCategoryCodes
+    def self.[](key)
+      @@codes[key]
+    end
+
+    @@codes = {
+    "X0"=>
+    {:code=>"X0",
+    :description=>"Supplemental Messages",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"10/16/2003",
+    :last_modified_date=>"",
+    :notes=>""},
+    "A0"=>
+    {:code=>"A0",
+    :description=>
+    "Acknowledgement/Forwarded-The claim/encounter has been forwarded to another entity.",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "A1"=>
+    {:code=>"A1",
+    :description=>
+    "Acknowledgement/Receipt-The claim/encounter has been received. This does not mean that the claim has been accepted for adjudication.",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "A2"=>
+    {:code=>"A2",
+    :description=>
+    "Acknowledgement/Acceptance into adjudication system-The claim/encounter has been accepted into the adjudication system.",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "A3"=>
+    {:code=>"A3",
+    :description=>
+    "Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system.",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "A4"=>
+    {:code=>"A4",
+    :description=>
+    "Acknowledgement/Not Found-The claim/encounter can not be found in the adjudication system.",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "A5"=>
+    {:code=>"A5",
+    :description=>
+    "Acknowledgement/Split Claim-The claim/encounter has been split upon acceptance into the adjudication system.",
+    :effective_date=>"02/28/2002",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "A6"=>
+    {:code=>"A6",
+    :description=>
+    "Acknowledgement/Rejected for Missing Information - The claim/encounter is missing the information specified in the Status details and has been rejected.",
+    :effective_date=>"10/31/2002",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "A7"=>
+    {:code=>"A7",
+    :description=>
+    "Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected.",
+    :effective_date=>"10/31/2002",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "A8"=>
+    {:code=>"A8",
+    :description=>"Acknowledgement / Rejected for relational field in error.",
+    :effective_date=>"10/31/2004",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "P0"=>
+    {:code=>"P0",
+    :description=>
+    "Pending: Adjudication/Details-This is a generic message about a pended claim. A pended claim is one for which no remittance advice has been issued, or only part of the claim has been paid.",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "P1"=>
+    {:code=>"P1",
+    :description=>
+    "Pending/In Process-The claim or encounter is in the adjudication system.",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "P2"=>
+    {:code=>"P2",
+    :description=>
+    "Pending/Payer Review-The claim/encounter is suspended and is pending review (e.g. medical review, repricing, Third Party Administrator processing).",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"01/27/2008",
+    :notes=>""},
+    "P3"=>
+    {:code=>"P3",
+    :description=>
+    "Pending/Provider Requested Information - The claim or encounter is waiting for information that has already been requested from the provider. (Note: A Claim Status Code identifying the type of information requested, must be reported)",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"01/27/2008",
+    :notes=>""},
+    "P4"=>
+    {:code=>"P4",
+    :description=>
+    "Pending/Patient Requested Information - The claim or encounter is waiting for information that has already been requested from the patient. (Note: A status code identifying the type of information requested must be sent)",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"01/27/2008",
+    :notes=>""},
+    "P5"=>
+    {:code=>"P5",
+    :description=>"Pending/Payer Administrative/System hold",
+    :effective_date=>"10/31/2006",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "F0"=>
+    {:code=>"F0",
+    :description=>
+    "Finalized-The claim/encounter has completed the adjudication cycle and no more action will be taken.",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "F1"=>
+    {:code=>"F1",
+    :description=>"Finalized/Payment-The claim/line has been paid.",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "F2"=>
+    {:code=>"F2",
+    :description=>"Finalized/Denial-The claim/line has been denied.",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "F3"=>
+    {:code=>"F3",
+    :description=>
+    "Finalized/Revised - Adjudication information has been changed",
+    :effective_date=>"02/28/2001",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "F3F"=>
+    {:code=>"F3F",
+    :description=>
+    "Finalized/Forwarded-The claim/encounter processing has been completed. Any applicable payment has been made and the claim/encounter has been forwarded to a subsequent entity as identified on the original claim or in this payer's records.",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "F3N"=>
+    {:code=>"F3N",
+    :description=>
+    "Finalized/Not Forwarded-The claim/encounter processing has been completed. Any applicable payment has been made. The claim/encounter has NOT been forwarded to any subsequent entity identified on the original claim.",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "F4"=>
+    {:code=>"F4",
+    :description=>
+    "Finalized/Adjudication Complete - No payment forthcoming-The claim/encounter has been adjudicated and no further payment is forthcoming.",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "F5"=>
+    {:code=>"F5",
+    :description=>"Finalized/Cannot Process",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"10/16/2003",
+    :last_modified_date=>"",
+    :notes=>""},
+    "R0"=>
+    {:code=>"R0",
+    :description=>
+    "Requests for additional Information/General Requests-Requests that don't fall into other R-type categories.",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "R1"=>
+    {:code=>"R1",
+    :description=>
+    "Requests for additional Information/Entity Requests-Requests for information about specific entities (subscribers, patients, various providers).",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "R3"=>
+    {:code=>"R3",
+    :description=>
+    "Requests for additional Information/Claim/Line-Requests for information that could normally be submitted on a claim.",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"02/28/1998",
+    :notes=>""},
+    "R4"=>
+    {:code=>"R4",
+    :description=>
+    "Requests for additional Information/Documentation-Requests for additional supporting documentation. Examples: certification, x-ray, notes.",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"02/28/1998",
+    :notes=>""},
+    "R5"=>
+    {:code=>"R5",
+    :description=>
+    "Request for additional information/more specific detail-Additional information as a follow up to a previous request is needed. The original information was received but is inadequate. More specific/detailed information is requested.",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"06/30/1998",
+    :notes=>""},
+    "R6"=>
+    {:code=>"R6",
+    :description=>
+    "Requests for additional information - Regulatory requirements",
+    :effective_date=>"02/28/2007",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "R7"=>
+    {:code=>"R7",
+    :description=>
+    "Requests for additional information - Confirm care is consistent with Health Plan policy coverage",
+    :effective_date=>"02/28/2007",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "R8"=>
+    {:code=>"R8",
+    :description=>
+    "Requests for additional information - Confirm care is consistent with health plan coverage exceptions",
+    :effective_date=>"02/28/2007",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "R9"=>
+    {:code=>"R9",
+    :description=>
+    "Requests for additional information - Determination of medical necessity",
+    :effective_date=>"02/28/2007",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "R10"=>
+    {:code=>"R10",
+    :description=>
+    "Requests for additional information - Support a filed grievance or appeal",
+    :effective_date=>"02/28/2007",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "R11"=>
+    {:code=>"R11",
+    :description=>
+    "Requests for additional information - Pre-payment review of claims",
+    :effective_date=>"02/28/2007",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "R12"=>
+    {:code=>"R12",
+    :description=>
+    "Requests for additional information - Clarification or justification of use for specified procedure code",
+    :effective_date=>"02/28/2007",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "R13"=>
+    {:code=>"R13",
+    :description=>
+    "Requests for additional information - Original documents submitted are not readable. Used only for subsequent request(s).",
+    :effective_date=>"02/28/2007",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "R14"=>
+    {:code=>"R14",
+    :description=>
+    "Requests for additional information - Original documents received are not what was requested. Used only for subsequent request(s).",
+    :effective_date=>"02/28/2007",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "R15"=>
+    {:code=>"R15",
+    :description=>
+    "Requests for additional information - Workers Compensation coverage determination.",
+    :effective_date=>"02/28/2007",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "R16"=>
+    {:code=>"R16",
+    :description=>
+    "Requests for additional information - Eligibility determination",
+    :effective_date=>"02/28/2007",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "RQ"=>
+    {:code=>"RQ",
+    :description=>
+    "General Questions (Yes/No Responses)-Questions that may be answered by a simple 'yes' or 'no'.",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"01/01/2008",
+    :last_modified_date=>"07/09/2007",
+    :notes=>""},
+    "E0"=>
+    {:code=>"E0",
+    :description=>"Response not possible - error on submitted request data",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"02/28/2002",
+    :notes=>""},
+    "E1"=>
+    {:code=>"E1",
+    :description=>"Response not possible - System Status",
+    :effective_date=>"02/29/2000",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "E2"=>
+    {:code=>"E2",
+    :description=>
+    "Information Holder is not responding; resubmit at a later time.",
+    :effective_date=>"06/30/2003",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "E3"=>
+    {:code=>"E3",
+    :description=>"Correction required - relational fields in error.",
+    :effective_date=>"01/24/2010",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "E4"=>
+    {:code=>"E4",
+    :description=>
+    "Trading partner agreement specific requirement not met: Data correction required. (Note: A status code identifying the type of information requested must be sent)",
+    :effective_date=>"01/30/2011",
+    :deactivation_date=>"",
+    :last_modified_date=>"",
+    :notes=>""},
+    "D0"=>
+    {:code=>"D0",
+    :description=>
+    "Data Search Unsuccessful - The payer is unable to return status on the requested claim(s) based on the submitted search criteria.",
+    :effective_date=>"01/01/1995",
+    :deactivation_date=>"",
+    :last_modified_date=>"09/20/2009",
+    :notes=>""}}
+  end
+end