Claim Submissions History Report shows the history of all submitted claims and received remittance advice transactions on both claim and activity levels. It can be used to cross check other reports or reports generated by other systems to make sure data is consistent across all data sources.
Data is grouped by months using Header.TransactionDate from the respective transaction. The report contains the following worksheets:
CS Claims History worksheet
The worksheet contains history of all claims submitted by the provider in Claim.Submission transactions.
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| Column | CS Field | Description |
|---|---|---|
| File Name | Name of Claim.Submission transaction from Post Office. | |
| Submission Date | Header.TransactionDateThis column uses the Date and Time Format | Transaction date of Claim.Submission transaction. |
| Sender ID | Header.SenderID | License number of a facility that is the sender of Claim.Submission transaction. |
| Sender Name | Organization Organisation name of a facility that is the sender of Claim.Submission transaction. | |
| Receiver ID | Header.ReceiverID | License number of an insurance company or TPA that is the receiver of Claim.Submission transaction. |
| Receiver Name | Organization name of the receiverOrganisation name of an insurance company or TPA that is the receiver of Claim.Submission transaction. | |
| Payer ID | Claim.PayerID | License number of an insurance company that is the payer of a claim. |
| Payer Name | Organization name of Organisation name of an insurance company that is the payer of a claim. | |
| Claim ID | Claim.ID | Unique identifier assigned to a claim by the provider. |
| Claim ID Payer | Claim.IDPayer | Unique identifier assigned to a claim by the payer. |
| Member ID | Claim.MemberID | Insurance card number of the patient. |
| MRN | Encounter.PatientID | Patient Medical Record NumberNumber assigned by the provider. |
| Encounter Start | Encounter.Start | Encounter start date and time. |
| Encounter End | Encounter.End | Encounter end date and time. If a claim has more than one encounter, Encounter.End from the first encounter is used. |
| Claimed Amount | Claim.Net | Net amount billed by the provider to the payer for a claim. |
| Is Resubmitted | Yes if a claim has been resubmitted in another transaction. In this case, the report is expected to have another claim with Resubmission Type on the next line. | |
| Resubmission Type | Resubmission.Type | Type of resubmission. If a claim is not a resubmission, then the column is empty. |
| Is Duplicate | False if the a claim is not a duplicate or ; |
Data in the worksheet is sorted by:
- Submission Date, descending;
- Claim ID, ascending.
CS Activities History worksheet
The worksheet contains history of all claim activities submitted by the provider in Claim.Submission transactions.
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| Column | CS Field | Description |
|---|---|---|
| File Name | Name of Claim.Submission transaction from Post Office. | |
| Submission Date | Header.TransactionDateThis column uses the Date and Time Format | Transaction date of Claim.Submission transaction. |
| Sender ID | Header.SenderID | License number of a facility that is the sender of Claim.Submission transaction. |
| Sender Name | Organization Organisation name of a facility that is the sender of Claim.Submission transaction. | |
| Receiver ID | Header.ReceiverID | License number of an insurance company or TPA that is the receiver of Claim.Submission transaction. |
| Receiver Name | Organization name of Organisation name of an insurance company or TPA that is the receiver of Claim.Submission transaction. | |
| Payer ID | Claim.PayerID | License number of an insurance company that is the payer of a claim. |
| Payer Name | Organization name of Organisation name of an insurance company that is the payer of a claim. | |
| Claim ID | Claim.ID | Unique identifier assigned to a claim by the provider. |
| Claim ID Payer | Claim.IDPayer | Unique identifier assigned to a claim by the payer. |
| Member ID | Claim.MemberID | Insurance card number of the patient. |
| MRN | Encounter.PatientID | Patient Medical Record NumberNumber assigned by the provider. |
| Activity ID | Activity.ID | Unique identifier of an activity within a claim. |
| Code | Activity.Code | Activity code specified by activity type. |
| Description | Activity code description. | |
| Auth. Number | Activity.PriorAuthorizationID | Prior authorization number. |
| Service Date | Activity.Start | Start date of an activity. |
| Claimed Amount | Activity.Net | Net amount billed by the provider to the payer for an activity. |
| Is Resubmitted | This The column has the same value as the a related claim on Submission Submissions History Report format. | |
| Resubmission Resubmission Type | Resubmission.Type | This The column has the same value as the a related claim on Submission Submissions History Report format. |
| Is Duplicate | This column has the same value as the related claim on Submission History Report formatFalse if a related claim is not a duplicate; True if a relaed claim is a duplicate. |
Data in the worksheet is sorted by:
- Submission Date, descending;
- Claim ID, ascending;
- Activity ID, ascending.
RA Claims History worksheet
The worksheet contains history of all claims submitted by the payer in Remittance.Advice transactions.
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| Column | RA Field | Description |
|---|---|---|
| File Name | Name of Remittance.Advice transaction from Post Office. | |
| Submission Date | Header.TransactionDateThis column uses the Date and Time Format | Transaction date of Remittance.Advice transaction. |
| Sender ID | Header.SenderID | License number of an insurance company or TPA that is the sender of Remittance.Advice transaction. |
| Sender Name | Organization Organisation name of an insurance company or TPA that is the sender of Remittance.Advice transaction. | |
| Receiver ID | Header.ReceiverID | License number of a facility that is the receiver of Remittance.Advice transaction. |
| Receiver Name | Organization name of Organisation name of a facility that is the receiver of Remittance.Advice transaction. | |
| Claim ID | Claim.ID | Unique identifier assigned to a claim by the provider. |
| Claim ID Payer | Claim.IDPayer | Unique identifier assigned to a claim by the payer. |
| Member ID | Claim.MemberID | Insurance card number of patient.Note: This value is taken from the respective Claim.Submission transactionthe patient. |
| MRN | Encounter.PatientID | Patient Medical Record Number .Note: This value is taken from the respective Claim.Submission transaction.assigned by the provider. |
| Processed Amount | Sum of all Activity.Net in the a claim. | |
| Paid Amount | Sum of all Activity.PaymentAmount in the a claim. | |
| Settlement Date | Claim.DateSettlement | Date the payer settles a claim. |
| Payment Reference | Claim.PaymentReference | Unique identifier for the payment transaction (cheque number, bank transfer number, payment voucher number). |
| Is Duplicate | False if a claim is not a duplicate or ; True if a claim is a duplicate. This column has the same logic as explained for 73675954. |
Data in the worksheet is sorted by:
- Submission Date, descending;
- Claim ID, ascending.
RA Activities History worksheet
The worksheet contains history of all claim activities submitted by the payer in Remittance.Advice transactions.
...
| Column | CS Field | Description |
|---|---|---|
| File Name | Name of Remittance.Advice transaction from Post Office. | |
| Submission Date | Header.TransactionDateThis column uses the Date and Time Format | Transaction date of Remittance.Advice transaction. |
| Sender ID | Header.SenderID | License number of an insurance company or TPA that is the sender of Remittance.Advice transaction. |
| Sender Name | Organization Organisation name of an insurance company or TPA that is the sender of Remittance.Advice transaction. | |
| Receiver ID | Header.ReceiverID | License number of a facility that is the receiver of Remittance.Advice transaction. |
| Receiver Name | Organization name of Organisation name of a facility that is the receiver of Remittance.Advice transaction. | |
| Claim ID | Claim.IDName | of the receiverUnique identifier assigned to a claim by the provider. |
| Claim ID Payer | Claim.IDPayer | Unique identifier assigned to a claim by the payer. |
| Member ID | Claim.MemberID | Insurance card number of the patient. Note: This value is taken from the respective Claim.Submission transaction. |
| MRN | Encounter.PatientID | Patient Medical Record Number .Note: This value is taken from the respective Claim.Submission transaction.assigned by the provider. |
| Activity ID | Activity.ID | Unique identifier of an activity within a claim. |
| Code | Activity.Code | Activity code specified by activity type. |
| Description | Activity code description. | |
| Auth. Number | Activity.PriorAuthorizationID | Prior authorization number. Note: This value is taken from the respective Claim.Submission transaction. |
| Service Date | Activity.Start | Start date of an activity. |
| Processed Amount | Activity.Net | Net amount billed by the provider to the payer for an activity. |
| Paid Amount | Activity.PaymentAmount | Amount paid by the payer for an activity. |
| Denial Code | Activity.DenialCode | Denial code for a rejected activity. |
| Denial Reason | Description of the denial Denial code description. | |
| Settlement Date | Claim.DateSettlement | Date the payer settles a claim. |
| Payment Reference | Claim.PaymentReference | Unique identifier for the payment transaction (cheque number, bank transfer number, payment voucher number). |
| Is Duplicate | This column has the same value as the related claim on Submission History Report formatFalse if a related claim is not a duplicate; True if a relaed claim is a duplicate. |
Data in the worksheet is sorted by:
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