Get Adjudication Message after Submitting a Claim

The response you receive at the time of submission would let you know the claim has passed clearinghouse level processing, and will be sent to the payer during our next processing window. The payer-specific response information can be obtained through the Claims Responses and Reports V2 API. The Claims Responses and Reports v2 API provides a direct connection to your mailbox where payers will send their final claims responses and reports. Use this API to access your mailbox for all the files containing complete information about claim payments, claim status updates, and other communications regarding revenue cycles and adjudication from the payer. Refer to this documentation about the recommend files to be used.

The R5 report specifically contains payment/denial information.

We do not recommend you to only check the R5 file as you would be missing anything related to rejected claims by using only that.

Please review the Available Responses and Reports for processing the claims.