Claims Search Result
The following conditions and rules apply when searching claims or claims lines.
Access Restrictions
The retrieval of claims data is subject to restrictions described in the Data Access Restriction.
Non-matched Fields
Non-matched fields are not considered when evaluating whether a claim meets the search criteria.
To clarify, consider the following example: the serviced person on the claim is null, the serviced person on the claim line is the person with relation code '1234'. When executing a search with the criterion that the serviced person relation code is 1234, this particular claim is not a valid search result, because only the serviced person as specified on the claim is considered, which is in this case null.
Service Start and End Date
The service start and end date act as boundaries: if the claim start and end date lie within the specified search period, then the claim is an eligible search result. Claims that have neither a start nor end date should not be found if a from and/or through service date are specified. Note that the start date on the claim represents the earliest claim line start date. The claim end date reflects the latest date of all claim line start or end dates.
For example, consider the following claims for person 123:
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Claim A, with service dates 2022-01-01 through 2022-01-15
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Claim B, with service dates 2022-01-10 through 2022-01-30
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Claim C, with no service dates
Consider the following search periods for claims for person 123 and the search results
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From <empty> through <empty> returns A, B and C
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From 2022-01-01 through <empty> returns A and B
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From <empty> through 2022-01-20 returns A
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From 2022-01-01 through 2022-01-20> returns A
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From 2022-01-08 through 2022-02-08> returns B
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From 2022-01-10 through 2022-01-20> returns nothing
Claims Lines
When searching for a claim line with a specific procedure code, that code is matched against all three claim line procedures.
When searching for a claim line with a specific diagnosis code, that code is matched against all claim line diagnoses including the diagnoses that are inherited from higher levels.
When searching for a claim line with a specific error message code, that code is matched against all claim line messages including the fatal messages that are inherited from higher levels.
When searching for a claim line with a specific pend reason code, that code is matched against all claim line pend reasons.