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Claim Status 

Select the Frequently Asked Question to view answer.
  1. How can I determine the status of a claim I submitted to Healthcare and Family Services?

    There are a couple electronic methods in which HFS makes this information available to those authorized to access it. With any of these methods, it will take seven days from the date of submission for a claim to register within HFS claim status system. Failing to wait these seven days prior to making an inquiry will return incomplete information. Additionally, due to the volume of claims processed by the department, this information is only available for two years from the date of the voucher.

    Our Medical Electronic Data Interchange (MEDI) / Internet Electronic Claims (IEC) system can be used to determine the status of your claims. MEDI/IEC allows for either real-time claim status inquiry using Direct Data Entry (DDE) or batch inquiries using the HIPAA-mandated X12 276/277 transactions.

    DDE: After the seven day wait period, the DDE system will provide you an immediate response on the status of a single claim for up to 90 days from the Date of Voucher for NIPS/Pharmacy claims and 180 days for Institutional claims. Status checks on claims with a Voucher Date older than 90/180 days must be performed using the batch 276 transaction described below. DDE is available M-F 8 a.m. to 5 p.m. CT.

    Batch: After the seven day wait period, the batch system will allow you to perform either a single inquiry for a claim not meeting the DDE date criteria above (example: a claim with a voucher date older than prescribed above) or to perform an inquiry for multiple claims in one batch. Batch inquiries (276) are accumulated throughout the day and their corresponding response transactions (277) are returned the next business day. The uploading of batch files is available 24 hours a day, 7 days a week. Batch files submitted to the Department by 5 p.m. CT M-F will be processed that night and the corresponding responses should be available the next business day.

    For crosswalk information on status codes, please refer to the provider notice dated January 27, 2005, found under All Medical Assistance Providers Notices. Please visit the MEDI/IEC Web site for more information.

    Some of the departments' Recipient Eligibility Verification (REV) vendors have electronic systems that provide claim status information to their customers. For more information on REV vendors, please contact one of these vendors.

    Finally, you can contact the Bureau of Comprehensive Health Services toll-free at 1-877-782-5565. However, due to the volume of calls the Department is experiencing, it is highly recommended that you use one of these other methods.