A Claim consists of one or more Claim Items . The Claim Item Status Code identifies what action has been taken on that particular Claim Item. N-FOCUS has nine different Claim Item Status Codes.
Approved: Claim Item in approved status will be paid during the batch process. The Status code will change to paid during the nightly Payments batch run.
Authorized: Claim Item in authorized status has been reviewed by Claims Processing staff and is approved to pay but another Claim Item on the same Claim is in suspended status. The Claim Item in authorized status will automatically change to approved status when the remaining Claim Items on the Claim in suspended status are either approved, ignored, postponed, or rejected.
Canceled: A payment/warrant has been returned to DHHS. When the payment/warrant is cancelled it will automatically set the status code of the affected Claim Items to cancelled.
Ignored: Claim Item in ignored status is the result of an internal error (data entry error). A claim item in ignored status will not be printed on an EOB.
Paid: Claim Items are paid during the nightly Payments batch run. All Claim Items in approved status will be set to paid in the batch process. Claim Item detail will be printed on the EOB.
Postponed: Claim Item in postponed status has an error that must be resolved by the Local Office worker. Claim is returned to the Local Office and remains in postponed status until the worker resubmits the claim or submits a new claim. If the worker resubmits the same claim, the Claims Processing staff will review the postponed Claim Item and correct the Claim Item accordingly and revalidate the Claim Item. If the worker submits a new Claim it will be processed as a new Claim and the original postponed Claim Item will remain in postponed status.
Preprint: N-FOCUS generates preprints for providers who have the preprint indicator set on their Provide Detail. Preprints are generated Weekly, Biweekly, or Monthly. When the Preprint batch process runs Claim Items are created in Preprint status and remain in that status until the providers submit the claim for processing.
If every line on a Claim remains in preprint status for 6 months the system will purge that Claim. The purge process runs every January and July.
Rejected: Claim Item in rejected status has been reviewed by Claims Processing staff and will not be considered for payment. This Claim Item will be printed on the Rejected EOB.
Suspended: Claim Item in suspended status must be reviewed by Claims Processing staff. Claim Items are suspend for a variety of reasons (i.e.: Received date prior to billing date, Invalid DHHS Office code, Service Authorization not found, Duplicate Claim Item, etc.) After Claims Processing staff has reviewed the Claim Item and made the necessary correction the Claim Item will be approved.
(11-2005)