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Purpose of the Claim Status Inquiry
Claim Status inquiries are used to inquire about the status of a claim after it has been sent to a payer,
whether submitted on paper or electronically.
Completing the Claim Status Inquiry Form:
Indicate Payer (Required)
Select a payer from the drop-down list. By selecting a specific payer, you will notice the list below will change
indicating the providers associated with the payer.
Searching for Providers (Required)
By using the search box, you can enter information for any of the search criteria option listed including:
Claim Information and Subscriber Information
The following are required:
If you do not enter the required information, the submit button will be 'greyed' out until all required fields are entered. Click on "Information" icon for required fields for each section and additional information.
Claim Status Detail
If only one claim is found for the submitted information, users will be immediately directed to the
Claim Status Detail page.
If there are multiple claims for the submitted information, the user will need to select the claim from the
presented list in order to be directed to the Claim Status Detail page.
Helpful Hints For All Payers
Internet Settings to promote optimal usage.
The user should access their "Internet Options" folder from Control Panel and click on settings in the Temporary
Internet Files section. When the new window pops up they should make sure that their stored pages are being
refreshed on "Every visit to the page". If these setting adjustments are not made,
you may see results from a prior inquiry.
Searching logic: When the provider enters a claim number, the payers will only search by claim number and National
Provider ID and dates of service even if this information was provided correctly.
**Important Notice ** This claim status transaction is not intended to replace the provider's voucher or
electronic remittance (835). Providers should not use this transaction to post finalized claims.
WNY HEALTHeNET must follow the HIPAA implementation guide which does not support returning coinsurance,
copays, deductibles, and ex codes etc. This date is returned on the 835.
Payer Specific Helpful Hints
Fidelis Care New York Processing Rules for HEALTHeNET Claims Status Lookup
The Member Number must be provided. The Subscriber ID, Patient First Name, Last Name, DOB and Gender must match
if all of those data elements are sent in the data. If only the Subscriber ID, Last Name and DOB are submitted,
then they must be an exact match. If the optional data is not present,
then they are not used for the matching criteria.
Univera Healthcare Processing Rules for HEALTHeNET Claims Status Lookup
Univera Healthcare requires Member ID/Name and DOB, and the NPI has to be related
to the claim for the provider requesting status.
NOVA Healthcare Administrators, Inc. Processing Rules for HEALTHeNET Claims Status Lookup
The system is designed to return claim status lookup on members if they can be uniquely identified by
completing the following information starting with Subscriber Information: Last Name, First Name:
Subscriber ID No.*, Date of Birth, and Gender.
*The subscriber ID No. MUST match the subscriber/card-holder's 9 digit ID number.
If any part of the Subscriber/Dependent information is not correct, the program will not return Claim Status Detail.
Please correct the information and resubmit the inquiry.
When a subscriber is located, the program determines if the member has claim status for date range entered.
If the member has active claim status, the results will be displayed under the
"claims information" on the Claims Status Detail.
If the Subscriber/Dependent has no results found for date range Under Claims Status
Detail Service Dates: will not be populated.