The Claim History page lists the transaction history for the selected claim. Each row represents a separate transaction associated with the claim identified by the following criteria:

Table 1: Claim Information

FieldDescription
Claim NumberClaim number assigned by the RRE/Insurer. 
Beneficiary NameName matched in the Beneficiary database associated with this claim.
Medicare ID

Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI) associated with this claim.

Note: This is also known as the Medicare Number to CMS’ Medicare beneficiaries.

CMS Date of InjuryDOI as defined by CMS associated with this claim.
Industry Date of InjuryDOI used by insurance/workers' compensation industry associated with this claim. 

Table 2: Transaction Information

FieldDescription
DCNDocument Control Number assigned to this transaction.
Transaction DateDate this transaction was last updated.
ActionTransaction type processed/requested for the claim. Values are Add, Update, or Delete.
StatusCurrent status of this transaction. Values include Saved Not Submitted, New, In Process, Error, Completed, or Deleted.
Disposition

Disposition of this transaction. Values are:

01 - Record accepted, applied at CWF

02 - Record accepted, no ORM reported

03 - Record accepted, but coverage period does not overlap with the injured party’s entitlement period

SP - Record received processing errors. 

Refer to the S111 NGHP User Guide on the CMS website for more information about errors.

Note: Processing errors will appear at the top of the Claim Information page.

Click Claim Listing or RRE Information to return to their respective pages.

September 2024

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