The Acknowledgment Report (Claims Acknowledgment (CA) Report) contains a list of claims processed by the Clearinghouse, along with indicators to show:
How each claim will be distributed to the payer (see the "D/C" column)
If claims failed any exclusions (this will prevent it from being forwarded to the payer)
How many additional claims (referred to as supplemental claims) will be billed submitted by the Clearinghouse (in the event you exceed six (6) line items for professional claims or twenty-three (23) line items for institutional claims.
The Summary Totals By CPID portion of this report will show the number of claims and claim amount for each CPID/State that was submitted. Once reviewed, this report becomes a historical record of claims processed.
The Exclusion Report contains claims that have been excluded by the Clearinghouse based on edits they receive from the payer. This report includes claim details followed by a brief explanation of why the claim was excluded. This report is intended to be a workable report for those who are assigned to 'cleaning up' submitted claims so they can be forwarded to the payer. All excluded claims for a particular payer will be grouped together.
The format of the Exclusion Report is modeled after the Acknowledgment Report so you can quickly identify information on either report. The totals from the Exclusion Report will match the totals of the Acknowledgment Report with the same processing date. While enough information is provided in the report for correcting most exclusions, there may be times when you will need assistance verifying why a claim was excluded, if so please Contact a Client Services Representative.
Payer Generated Report
The Payer Generated Report contains information about claims that were accepted and rejected by the payer's front end. Not all payers participate in submitting this type of report. The payer’s front end will either accept the claim and enter it in the payer’s adjudication system or deny the claim and submit it back to the Clearinghouse.
(SR) Payer Claim Data Report: Filenames that begin with SR are the Clearinghouse's version of the Payer Generated Report.
(SB) Payer Batch Totals Report: Filenames that begin with SB are Normalized Payer Batch Reports. These reports show only batch information from the payer reports.
(SE) Payer Claim Rejections Report: The Payer Claim Rejections report contain filenames that begin with an SE. This report presents payer claim reject information in a standard, human-readable format. Please note this report will contain only rejected claims.