ClaimReference Field in Submission Response

Suggest Edits

The claimReference field is an object containing the list of identifiers that you can use to track an Institutional Claims. If questions arise about a claim, you can provide the information listed in the claimReference object to Optum support for troubleshooting purposes. It appears in all Submission responses for claims, Institutional Claims API response. The list of identifiers may differ depending on the context for the response:

```json
{
    "status": "SUCCESS",
    "controlNumber": "000000001",
    "tradingPartnerServiceId": "9496",
    "claimReference": {
        "correlationId": "201007R999898~49588871937782918",
        "submitterId": "009998999898",
        "customerClaimNumber": "000000001",
        "patientControlNumber": "12345",
        "timeOfResponse": "2020-10-07T00:31:07.723-05:00",
        "claimType": "INS"
    }
}
```

The first response you get back from the clearinghouse does not indicate whether the claim is being paid; it indicates that the clearinghouse has accepted the claim and is getting ready to forward it to the payer.

ClaimReference object fields

claimReference is the response's main object. The fields in the claimReference object include the following:

Field	Description
`correlationId`	ID used by support to locate a transaction at the clearinghouse.
`submitterId`	The customer's combined biller ID and submitter ID. Describes the entity that submitted the claim. Value is in Loop 1000A, element NM109.
`customerClaimNumber`	ID set by the customer in the claim. An additional claim tracking number assigned by the clearinghouse.
`patientControlNumber`	ID set by the customer in the claim for the patient. Echoes the Patient `controlNumber` back from the original request.
`timeOfResponse`	Timestamp, date and time of the response from the clearinghouse.
`claimType`	Type of claim, Professional or Institutional. "PRO" for Professional or "INST" for Institutional.
`formatVersion`	EDI format version, will always be 5010 for the current version of the 837 claim, describes the X12 EDI version to which the claim conforms.
`rhclaimNumber`	Unique claim number to track the claim at the clearinghouse. You can use this value to search for the claim in ConnectCenter and check for updates.

If the Integrated Edits evaluation was successful, it reports an editStatus of "SUCCESS" and the claim will be forwarded to the payer.

Updated about 2 months ago