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Find claim payment information

Access the Claim Payments tab to find payment detail including who was paid, when and how, adjustment information and other payment information.

Only paid (P status) claims will have complete payment information. Claims that are in process, pended, being audited, or claims that have been released won't have complete information.

Access the Claim Payments tab

  1. Search for and open the claim.

  2. Select the Claim Payments option from the Claim menu, located in the session pane.

    Claim Payments - Info

At the top of the window, the Stop Loss indicator shows if the claim check was submitted to a stop-loss carrier and the Special Handling field tells you if a special delivery was required for the payment (e.g. FedEx overnight).

Update Stop Loss and Special Handling

If you have the required permissions to update these fields, follow the instructions below.

  1. Select Yes or No from the Stop Loss list.
  2. Use the Special Handling list to select one of the following codes or other codes specified for your check/EOBClosed EOBs are sent to members and payees to inform them of the disposition of claims. Typically an EOB identifies the date and type of service, the billed amount, deductibles, co-insurance, and an explanation of any ineligible charges. An EOB can also be a helpful tool in identifying fraudulent claims, as the member receives notification even when payment is made to the provider. An EOB isn't a bill. process.
    • 00—US Mail.
    • 01—FedEx Overnight.
    • 02—UPS Overnight.
    • 03—UPS Ground.

The Info tab lists all the payment information related to the claim. The columns identify the payee—provider, member, or other party—and contains the payment information for that payee.

If the payment is to the provider, you'll see the billing provider ID and name in the Provider column. Likewise, if the payment is to the member, you'll see the member ID and name in the Member column.

Field Description
Claim Refnos A unique alphanumeric claim identifier associated with the check.
ID Social security number for members or tax ID# for providers.
Name Name for whoever the claim check is issued to.
Check Address The address the claim check is sent.
Third Party Flag Y indicates the payment was issued to a third party, rather than the member.
Claim Paid Amount

Amount specified on the check.

  • This amount might not match the Check Amount. For example, with a batch check, the Total Paid Amount might be less than the Check Amount, but with an Overpayment Refund, the Total Paid Amount might be greater than the Check Amount.
Prior Payment Adjustment

Amount carried forward from a prior claim as an adjustment to the total amount paid for a claim. The amount could be negative or positive based on over or underpayments on the prior claims.

If the payment adjustment was taken at the billing provider level, (B) displays next to the amount. If it was taken at the service provider level, (S) displays next to the amount.
Draft Draft code associated with the claims check. Draft on which the claim check was issued.
Payment Type

How the payment was delivered.

  • CHK—Check
  • ACH—Direct deposit
  • VCC—Virtual credit card
Check Number Check number used to pay this claim.
EFT Trace Number Number that identifies the completed claims check.
Issued Date Date the check was originally issued.
Action Date Date the claims check was run. Defaults to the current date. The only time the action and issued date might be different is when the check is voided.
Check Status

Current status of the check, which includes:

  • PV—Pending Verification
  • V— Verified
  • IP—In process.
  • P—Printed.
  • WASTE—Wasted check.
Total Check Amount

Paid amount on the check.
Cleared Date Date the claim check was cleared by the bank.
Stop Payment Y indicates a stop payment was put on the check.
SubDraft Identifies the sub-accounts that share a host draft. A host draft defines the overall banking arrangement for a specific checking account.
Original Draft Original draft associated with the claim.
Invoice Date Date the invoice file was received from the trading partner.
  • Claims with a status other than P will either be blank or have incomplete information. See Claim statuses for more information.
  • If the claim has been adjusted, the reason code for the adjustment displays next to the status.

The Electronic Payment subtab contains Electronic Funds Transfer (EFT) information and Virtual Credit Card (VCC) information.

Field Description
ACH Drawdown Trace Number A unique number assigned to the ACHClosed An electronic funds-transfer system run by the National Automated Clearing House Association (NACHA). This payment system deals with payroll, direct deposit, tax refunds, consumer bills, tax payments and many more payment services. entry by an Originating Depository Financial Institution which identifies that drawdown entry.
ACH Disbursement Trace Number A unique number assigned to the ACHClosed An electronic funds-transfer system run by the National Automated Clearing House Association (NACHA). This payment system deals with payroll, direct deposit, tax refunds, consumer bills, tax payments and many more payment services. entry by an Originating Depository Financial Institution which identifies that disbursement entry.
ACH Effective Date Date the EFT ACHClosed An electronic funds-transfer system run by the National Automated Clearing House Association (NACHA). This payment system deals with payroll, direct deposit, tax refunds, consumer bills, tax payments and many more payment services. payment is effective.
ACH Cleared Date Date the EFTClosed Electronic funds transfer-money that is transferred electronically. payment is considered completed and the money is no longer pending in the recipient's bank account.
EFT Drawdown Date Date the EFT funds were pulled from the payer's bank account.
Card Token ID Virtual Credit Card (VCC) unique ID which replaces the check number.
Date Card Issued Date Virtual Credit Card (VCC) was issued.
Credit Card Expiration Date

Virtual Credit Card (VCC) expiration date.
Sequence Sequence number for the electronic payment.
Debit/Credit The transaction is either a debit (+) or a credit (-).
Debit/Credit Amount Amount debited or credited on the Virtual Credit Card (VCC) transaction.
Authorization Date Date the funds were authorized to be transferred from the payer's account. The format is YYYYMMDD.
Requested Date

Date the funds were requested from the payer's account by the payment processor. The format is YYYYMMDD.
Transferred Date

Date the funds were transferred from the payer's account by the payment processor. The format is YYYYMMDD.
Funding Status Status indicating that the funds to the payment processor completed the transfer.

The Transaction History subtab contains claim’s print vendor transaction information, if applicable.

Field Description
Transmission Date Date the print vendor transmitted the file.
Document Key

Key used to link print vendor file transactions (Emdeon, RedCard, etc.)

  • Consists of the vendor’s File Key (File Key = Client Number, Client Layout Number, Year, Month, Day, and Sequence Number) and six characters that uniquely identify the document within a specific file.
Pay Type

How the payment was delivered to the payee. This could be paper check, ACHClosed An electronic funds-transfer system run by the National Automated Clearing House Association (NACHA). This payment system deals with payroll, direct deposit, tax refunds, consumer bills, tax payments and many more payment services., or virtual credit card.

To track why, and when an adjustment is done on a paid (claim status—P) trading partner (BCBS, Anthem, UHC, etc.) claim, view the Adjustment Reason tab. You must have the proper access to view this tab. See Find a trading partner claim’s adjustment reason for details.

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