Claim Status. The MCOP shall notify providers who have submitted claims of claims status (paid denied, and all claims not in a final paid or denied status [hereinafter referred to as “pended/suspended”]) within one month of receipt by the MCOP or its designee. Such notification may be in the form of a claim payment/remittance advice produced on a routine monthly, or more frequent, basis. The MCOP provider portal shall allow for the availability of all remittance advices upon request and should be capable of elements such as the following submission, resubmission, and adjustment. If a provider and/or a provider's clearinghouse submits a HIPAA compliant 276 EDI transaction to the MCOP and/or the MCOP’s clearinghouse, the MCOP/clearinghouse shall respond with a complete HIPAA compliant 277 EDI transaction within the required Council for Affordable Quality Healthcare, Inc. (CAQH) Committee on Operating Rules for Information Exchange (CORE) timeframes with the HIPAA compliant claim status category code(s) and claim status code(s) that will provide information on all denied, paid, or pended claims to the submitter.
Claim Status. The MCOP shall notify providers who have submitted claims of claims status (paid, denied, or pended/suspended) within one month of receipt by the MCOP or its designee. Such notification may be in the form of a claim payment/remittance advice produced on a routine monthly, or more frequent, basis. The MCOP provider portal shall allow for the availability of all remittance advices upon request, and should be capable of elements such as the following submission, resubmission and adjustment.
Claim Status. The MCOP shall notify providers who have submitted claims of claims status (paid denied, and all claims not in a final paid or denied status [hereinafter referred to as “pended/suspended”]) within one month of receipt by the MCOP or its designee. Such notification may be in the form of a claim payment/remittance advice produced on a routine monthly, or more frequent, basis. The MCOP provider portal shall allow for the availability of all remittance advices upon request and should be capable of elements such as the following submission, resubmission, and adjustment. Effective January 1, 2020, the MCOP shall utilize a HIPAA compliant electronic data interchange (EDI) transaction, or another batch report process, to inform providers of claims status (paid, denied, or pended/suspended). If the MCOP chooses to use a batch report process rather than an EDI transaction, the claim status and reason shall be included in the report.
