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Use MN–ITS Request Claim Status (276/277) to Copy or Reverse a Claim

Date: 08-19-2015

The MN–ITS Request Claim Status response page allows you to check the status on all claims submitted through MN–ITS DDE, pharmacy point of sale and internal adjustment claims.

Claims submitted through MN–ITS (DDE) are accessible on the same day using the MN–ITS Request Claim Status (276) feature.

Limitations:

Limitations to copying or reversing claims include the following:

· Claims more than one year old are subject to timely billing requirements and may not be eligible for reimbursement.

· You will not be able to view claims more than three years old.

· You can only view internal adjustment claims; you cannot reverse. Call the MHCP Provider Call Center to have those claims reversed.

Steps to copy or reverse a pharmacy claim

Follow these steps:

1. Log in to MN–ITS.

2. From the left menu select Request Claim Status (276).

3. Complete the Claim Status Request.

· In the Quick Search section enter the following required fields:

· Enter the 8-digit MHCP recipient number in the Subscriber ID field.

· Enter the first date of service of your claim in the Service Date (From) field using MMDDYYYY format.

· To search for a span of dates enter the end date of service in the Service Date (To) field using MMDDYYYY format. Shortening the date span will narrow your search results.

· Pay-to Provider NPI/UMPI: (Billing Organizations Use Only) Billing Agent, Billing Intermediary or Consolidated Billing Entity – enter the pay-to provider’s 10-digit NPI/UMPI for the claim you are requesting to receive a valid response.

· In the Detail Search section, the following fields are optional. To narrow your search results, enter one of the following:

· In the Payer Claim Control Number (PCN) field, enter the 17-digit payer claim control number.

· In the Pharmacy Prescription Number field, enter the pharmacy prescription number up to 12 digits.

4. Use the Action buttons to complete or cancel your request:

· Select Close to cancel your request and return to the MN–ITS Home Page

· Select Submit to view your Claim Status Response (277). (You may briefly see a message stating: Your claim is processing. Please wait.) You will then see the detail about the claim. If multiple claims appear on your response, click on the claim with a paid amount.

· Click on Copy or Reversal to proceed.

Using MN–ITS Request Claim Status Response (277) to Copy a Claim

Use the copy feature if the claim you just submitted contains some or all of the information needed to submit a new claim. Follow these steps:

1. From the Request Claim Status Response, select the Copy action button to retrieve an exact copy of the claim that was just entered.

2. On the Pharmacy (NCPDP): Service Provider/Cardholder screen, click Continue.

3. If the claim is for a different subscriber, select Delete and enter the Subscriber ID and Birthdate, then click Search. If not, click Continue.

4. On the remaining screens complete the required (*) fields or appropriate situational field(s) (**) on each screen. Click the appropriate closed accordion panel sections or Continue to advance to the next screen.

Note: Refer to the appropriate MN–ITS User Guide and the specific service section of the MHCP Provider Manual for billing information and instructions on how to complete your specific claim type.

5. Select the Validate button to ensure you have completed all required fields. (You will get a prompt to complete any missing information before you can proceed.) If all required fields are completed, your claim information will be submitted and will bring you to a new screen that shows the status codes.

6. Review the Claim Status Category and Claim Status codes shown on this screen using the Washington Publishing Company link on the right side of the screen to determine if you need to make any corrections. Click Close to return to the Claim Information page.

7. Select the Submit button from the initial claim to submit the claim. Within seconds, you will receive a Claim Response similar to the Validate response with the claims control number (in orange) at the top.

For more information on your submitted response, refer to Understanding Your Claim Status Response (277).

Using MN–ITS Request Claim Status Response (277) to Reverse a Claim

You have the option to reverse a claim you may have submitted in error. If you clicked Reversal from the Claim Status Response, take the following actions:

· On the Pharmacy (NCPDP) Reversal Claim screen click Submit. This will reverse your original claim. Within seconds, you will receive a Claim Response similar to the Validate response with the claims Control number (in orange) at the top.

· Print a copy of the response by selecting the Print Page link in the upper right section of the response if you want to keep a copy.

Understanding Your Claim Status Response (277)

The 277 Claim Status Response contains the status of your claim and provides the remittance advice date if the claim has been paid or denied.

The claim response displays the Claim Information and the first Service Line on the claim with the WPC HIPAA compliant Claim Status Category and Claim Status codes that explain how the claim and line one were processed.

Any additional service lines are displayed as a blue collapsed accordion panel with the line number and a general service summary. You must select each line to review the HIPAA compliant codes and payment information to understand how the entire claim was processed.

You may print a copy of the response by selecting the Print Page link in the upper right section of the response.

After printing is complete, select Back to 277 Response. If you need to make additional changes, select the appropriate action button or select close to return to the MN–ITS Home page.