Response Contents - Professional Claims
Metadata for troubleshooting
Our Medical Network APIs support a significant troubleshooting feature called metadata. For more information, see Metadata for troubleshooting.
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 example in ClaimReference Field in Submission Response.
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.
Key values of claims response
| Key Value | Description |
|---|---|
customerClaimNumber | An additional claim tracking number assigned by the clearinghouse. |
submitterId | Describes the entity that submitted the claim. Value is in Loop 1000A, element NM109. |
patientControlNumber | Echoes the Patient controlNumber back from the original request. ✍️ In the sandbox request, using value: test00005 (lower case and not uppercase), forfieldName: patientControlNumber returns a EDITS canned response. |
timeOfResponse | Date and time of the response from the clearing house. |
formatVersion | Describes the X12 EDI version to which the claim confirms. |
claimType | "PRO" for Professional. "INST" for Institutional. |
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. |
Updated 3 months ago