hippo 0.0.10 → 0.0.11

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