MN–ITS Help – 276 Claim Status Request for 837D, 837I, 837P
The table below describes the individual fields on the Validate Response. * The Field Name column identifies X12 loops and elements when one exists in the 5010 ASC X12 Guide. Refer to the X12 HIPAA Companion Guides available through the WPC X12 Registry for additional instructions when submitting batch claims and request claim status.
Select:
- MN–ITS User Manual to find information about all the features within MN–ITS
- Direct Data Entry (DDE) and then select “Submit DDE Claims” to obtain the appropriate MN–ITS User Guide for additional instructions to submit claims
- Request Claim Status for instructions to retrieve and check the status of submitted claims
Field Name | Character Length | Field Description |
Quick Search | ||
Subscriber ID | 8/8 (numeric) | The 8-digit MHCP member identification number. |
Service Date (From) | 8/8 | The first date of service on the claim or the first date in a range of dates. |
Service Date (To) | 8/8 (numeric) | The last date of service on the claim or the last date in a range of dates. |
Pay-To Provider NPI/UMPI | 10/10 (alphanumeric) | Billing agents, billing intermediaries or consolidated billing entities enter the pay-to provider’s 10-digit NPI/UMPI for the claim they submitted on behalf of the pay-to-provider or to identify the service or recipient home location. |
Detail Search (optional) | ||
Payer Claim Control Number (PCN) | 17/17 (numeric) | The 17-digit payer claim control number assigned to the claim that was submitted. |
Prescription Number | 1/12 (numeric) | The12-digit Pharmacy Prescription Number assigned to the claim that was submitted. |
Screen Action Buttons | Use the following action buttons to:
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