Response Contents - Professional Claims
Metadata for troubleshooting
Our Medical Network APIs support a significant troubleshooting feature called metadata. For more information, see Troubleshoot APIs with Metadata.
NOTE
API users need not enable this capability; it is automatic and has no effect on information in any medical transaction. If you encounter any issues with a transaction and need to work with Optum technical support, give the values provided in the
metaobject to the Optum representative.
Claim response information
The primary elements of a medical claims submission response consist of the aforementioned meta object, and a claimReference object. It contains a number of tracking values. Please see API Example.
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 is the response's main object.
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. Echoes the Patient controlNumber back from the original request. ✍️ In the sandbox request, using value: test00005 (lower case and not uppercase), for fieldName: patientControlNumber returns a EDITS canned response. |
timeOfResponse | Timestamp, date and time of the response from the clearinghouse. |
claimType | Type of claim, Professional or Institutional. "PRO" for Professional "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 1 month ago