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Revised: 07.21.14

201 Report

With the exception of the remittance advice, the 201 Report is the most important claims related ‘report’ generated by the FISS system. 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. Currently the Medicare 201 Report is only available through the Direct Data Entry (DDE) system for CGS J15 providers. The Medicare 201 Report can be accessed daily through DDE.

The 201 Report provides information on pending, processed, and returned claims; however, information regarding pending, or suspended claims, claims that are processing through the Common Working File (CWF), RTPd claims, and claims that are in the payment floor (PB9996), are all displayed on the Claim Count Summary Screen (Option 56) under Inquiries (01 – Main Menu) in DDE.

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. 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

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. 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

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. 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

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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