License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

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201 Report

With the exception of the remittance advice, the 201 Report is the most important claims related report generated by the FISS system. Produced hardcopy on a weekly basis, this report has three main sections. Two are informational in nature, while the "Returned To Provider" section is extremely important because it identifies the claims that have not passed our edits and must be addressed by the provider before processing can resume. The 201 Report also has a daily version that can be accessed through the Direct Data Entry (DDE) system.

Pending Claims

The "Pending" section of the 201 Report lists all the claims that are pending within FISS as of the point in time the 201 Report is generated. For hardcopy versions, this is every Wednesday night. A claim will continue to appear on this section of the 201 Report until it has either been processed or "returned". The claims will be listed in alphabetical order based on the patient's last name. The report is also segmented to list claims of similar bill types together, such as inpatient, outpatient, etc. On DDE versions, the data reflects the status as of the conclusion of the previous work day. The following provides a definition of each heading within the report.

201 Report-Pending Claims Definitions

**201 Report-Pending Claims Definitions**
Title	Definition
NAME	Beneficiary name, alphabetized by last name
MED REC NUMBER	Medical Record number listed by provider on the claim.
HIC NUMBER	Beneficiary's Health Insurance Claim (Medicare) number
RECD DATE	Date claim received by CGS
ADMIT DATE	Date of admission
FROM/THRU DATE	Dates of service
ADJ IND	Adjustment indicator. This will be blank if the claim is an original. If the claim is an adjustment, this field will show an " * ".
LAST TRAN	Last Transaction Date, or the last date that CGS took action on this claim.
SUB IND	Submission Indicator, P= paper claim, A= electronic claim
SUSP TYPE	Suspense Type, identifies the location within the FISS system:
MED	Medical Review
MSP	Medicare Secondary Payer
CWFR	Common Working File Regular
CWFD	Common Working File Delayed
SUSP	Suspense, any other category not described above
TOTAL CHARGES	Total charges for the claim
ADS	Additional Development System. If no other information has been requested, this field will be blank. If additional information has been requested (i.e. medical records), this field will contain a " Y ".
ADS REASON CODES	Codes that identify the requested the information for the claim, if any.

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Processed Claims

The "Processed" section lists all claims that have been processed since the last generation of the 201 Report. For the hardcopy version, this covers the work days from Thursday through Wednesday. On the DDE version, the data reflects the status as of the conclusion of the previous work day. A claim will appear on this section only once for each time it is submitted.

201 Report-Processed Claims Definitions

**201 Report-Processed Claims Definitions**
Word	Definition
NAME	Beneficiary name, alphabetized by last name
MED REC NUMBER	Medical Record number listed by provider on the claim.
HIC NUMBER	Beneficiary's Health Insurance Claim (Medicare) number
RECD DATE	Date claim received by CGS
ADMIT DATE	Date of admission
FROM/THRU DATE	Dates of service
ADJ IND	Adjustment indicator. This will be blank if the claim is an original. If the claim is an adjustment, this field will show an " * ".
PAID DATE	The date claim will be paid or rejected.
CLEAN IND	Clean Claim Indicator
A	PIP Other
B	PIP Clean
C	NON-PIP Other
D	NON-PIP Clean
E	Additional info was requested (NON-PIP)
F	Additional info was requested (PIP)
G	Date of death overlaps claim, as result claim was developed (NON- PIP)
H	Date of death overlaps claim, as result claim was developed (PIP)
I	Non-definitive response from CWF requiring development (NON-PIP)
J	Non-definitive response from CWF requiring development (PIP)
K	Definitive response not received from CWF within 7 days (NON-PIP)
L	Definitive response not received from CWF within 7 days (PIP)
M	Claim manually set to "Other" (NON-PIP)
N	Claim manually set to "Other" (PIP)
O	Sequential claim in which the prior claim was pending & determined to be "Other", NON-PIP
P	Sequential claim in which the prior claim was pending & determined to be "Other" ( PIP)
REJECT CODE	The 5 digit code that identifies the reason for a reject.

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Returned Claims

The "Returned" section of the 201 Report lists all the claims that have failed the billing edits since the creation of the last report. For hardcopy versions, this covers the work days from Thursday through Wednesday.A claim will appear on this section of the 201 Report only once for each time it is submitted.It is crucial that this section of the 201 Report be monitored and worked on an on-going basis.The claims will be listed in alphabetical order based on the patient's last name. The report is also segmented to list claims of similar bills types together, such as inpatient, outpatient, etc. On DDE versions, the data reflects the status as of the conclusion of the previous work day.

201 Report-Returned Claims Definitions

**201 Report-Returned Claims Definitions**
Word	Definition
NAME	Beneficiary name, alphabetized by last name
MED REC NUMBER	Medical Record number listed by provider on the claim.
HIC NUMBER	Beneficiary's Health Insurance Claim (Medicare) number
RECD DATE	Date claim received by CGS
ADMIT DATE	Date of admission
FROM/THRU DATE	Dates of service
ADJ IND	Adjustment indicator. This will be blank if the claim is an original. If the claim is an adjustment, this field will show an " * ".
RTP DATE	Returned to Provider Date. The date it was determined that an error appeared on the claim.

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