Friday, June 13, 2008

Amerigroup Corp unknown payer response code

RelayHealth has been made aware of an issue with the MEDAVANT DATA FILE report for CPID 1741 - Amerigroup Corp that has been occurring since processing date of March 28, 2008. As a result, the intermediary produced an invalid message of UNKNOWN PAYER RESPONSE CODE. The intermediary is working to correct the issue and is determining whether they will be able to reproduce corrected reports.
The actual code that is being returned with the message is correct and should be referenced to obtain claim status. Below is a listing of the codes and their correct corresponding message descriptions.

20 - Carrier acknowledges receipt of the claim
30 - Claim is pending at receiver site
40 - All services paid/claim adjudication process has been completed by carrier
50 - Claim requires special handling
51 - Missing or invalid data
56 - Invalid date of service
61 - Provider is not an electronic submitter
83 - No active coverage exists
86 - Invalid provider ID
99 - Close out
4P - Completed: Payment made according to plan provisions
4Q - Complete; payment has been denied
4Y - Adjustments
5Z - Provider not on file
7Q - Partial denial
8U - Invalid procedure
8Z - Unable to process electronically
T5 - Need rendering name, address, phone number
BF - Subscriber/Member ID not found
PB - Pending: Under final processing - no action required at this time
PG - Pending: Claim in process - no action required at this time
QA - Missing or invalid provider NPIQC - NDC missing

Action Required: Please be aware of any invalid rejections returned from the intermediary and reference the code for claim status.

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