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.
The table below describes columns presented on this worksheet.
| Column | CS Field | Description |
|---|---|---|
| File Name | Name of Claim.Submission transaction from Post Office. | |
| Submission Date | Header.TransactionDate | This column uses the Date and Time Format. |
| Sender ID | Header.SenderID | |
| Sender Name | Organization name of the sender. | |
| Receiver ID | Header.ReceiverID | |
| Receiver Name | Organization name of the receiver. | |
| Payer ID | Claim.PayerID | |
| Payer Name | Organization name of the payer. | |
| Claim ID | Claim.ID | |
| Claim ID Payer | Claim.IDPayer | |
| Member ID | Claim.MemberID | Insurance card number of patient. |
| MRN | Encounter.PatientID | Patient Medical Record Number. |
| Encounter Start | Encounter.Start | If a claim has more than one encounter, Encounter.Start from the first encounter is used. |
| Encounter End | Encounter.End | If a claim has more than one encounter, Encounter.End from the first encounter is used. |
| Claimed Amount | Claim.Net | |
| 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. No otherwise. | |
| Resubmission Type | Resubmission.Type | Type of resubmission. If a claim is not a resubmission, then the column is empty. |
| Is Duplicate | False if the claim is not duplicate or True if the claim is duplicate. For example, if there are three copies of Claim ID 123, then one record with this claim has value False in this column, and two other records will have value True. |
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.
The table below describes columns presented on this worksheet.
| Column | CS Field | Description |
|---|---|---|
| File Name | Name of Claim.Submission transaction from Post Office. | |
| Submission Date | Header.TransactionDate | This column uses the Date and Time Format. |
| Sender ID | Header.SenderID | |
| Sender Name | Organization name of the sender. | |
| Receiver ID | Header.ReceiverID | |
| Receiver Name | Organization name of the receiver. | |
| Payer ID | Claim.PayerID | |
| Payer Name | Organization name of the payer. | |
| Claim ID | Claim.ID | |
| Claim ID Payer | Claim.IDPayer | |
| Member ID | Claim.MemberID | Insurance card number of patient. |
| MRN | Encounter.PatientID | Patient Medical Record Number. |
| Activity ID | Activity.ID | |
| Code | Activity.Code | |
| Description | Activity code description. | |
| Auth. Number | Activity.PriorAuthorizationID | Prior authorization number. |
| Service Date | Activity.Start | |
| Claimed Amount | Activity.Net | |
| Is Resubmitted | This column has the same value as the related claim on Submission History Report format. | |
| Resubmission Type | Resubmission.Type | This column has the same value as the related claim on Submission History Report format. |
| Is Duplicate | This column has the same value as the related claim on Submission History Report format. |
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.
The table below describes columns presented on this worksheet.
| Column | RA Field | Description |
|---|---|---|
| File Name | Name of Remittance.Advice transaction from Post Office. | |
| Submission Date | Header.TransactionDate | This column uses the Date and Time Format. |
| Sender ID | Header.SenderID | |
| Sender Name | Organization name of the sender. | |
| Receiver ID | Header.ReceiverID | |
| Receiver Name | Organization name of the receiver. | |
| Claim ID | Claim.ID | |
| Claim ID Payer | Claim.IDPayer | |
| Member ID | Claim.MemberID | Insurance card number of 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. |
| Processed Amount | Sum of all Activity.Net in the claim. | |
| Paid Amount | Sum of all Activity.PaymentAmount in the claim. | |
| Settlement Date | Claim.DateSettlement | |
| Payment Reference | Claim.PaymentReference | |
| Is Duplicate | False if a claim is not duplicate or True if a claim is 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.
The table below describes columns presented on this worksheet.
| Column | CS Field | Description |
|---|---|---|
| File Name | Name of Remittance.Advice transaction from Post Office. | |
| Submission Date | Header.TransactionDate | This column uses the Date and Time Format. |
| Sender ID | Header.SenderID | |
| Sender Name | Organization name of the sender. | |
| Receiver ID | Header.ReceiverID | |
| Receiver Name | Organization name of the receiver. | |
| Claim ID | Claim.ID | Name of the receiver. |
| Claim ID Payer | Claim.IDPayer | |
| Member ID | Claim.MemberID | Insurance card number of 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. |
| Activity ID | Activity.ID | |
| Code | Activity.Code | |
| 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 | |
| Processed Amount | Activity.Net | |
| Paid Amount | Activity.PaymentAmount | |
| Denial Code | Activity.DenialCode | |
| Denial Reason | Description of the denial code. | |
| Settlement Date | Claim.DateSettlement | |
| Payment Reference | Claim.PaymentReference | |
| Is Duplicate | This column has the same value as the related claim on Submission History Report format. |
Data in the worksheet is sorted by:
- Submission Date, descending;
- Claim ID, ascending.
- Activity ID in ascending order.