Cortex EDI - Real-Time CSI Sample Response

Real-Time CSI CMN Status Sample Response (including Same or Similar)


  ________                 PROVIDER CMN STATUS DISPLAY SCREEN            VMSPI03 
                                                                                
     CARRIER NO:   18003          NPI:  1234567890                              
  HICN:  123456789A                                                            
 SUBMITTED HCPCS: E0163NU   APPROVED HCPCS: E0163NU    INIT DT: 01/12/2010      
   STATUS: CI CLOSED PUR PRICE MET  STATUS DT: 01/18/2010       LENGTH: 99      
   TYPE: 1 INITIAL       TOT RENTAL PMTS: 00  RECERT/REVISE DT:                 
   SUPPLIER NAME: ABC MEDICAL SUPPLY             LAST CLAIM DT: 01/12/2010      
   SUPPLIER PHONE: 555-555-5555                                                 
                                                                                
 SUBMITTED HCPCS: E0260RR   APPROVED HCPCS: E0260RR    INIT DT: 11/20/2009      
   STATUS: DM SYS GEN NON DRUG      STATUS DT: 11/30/2009       LENGTH: 13      
   TYPE: 1 INITIAL       TOT RENTAL PMTS: 11  RECERT/REVISE DT:                 
   SUPPLIER NAME: XYZ MEDICAL SUPPLY             LAST CLAIM DT: 10/20/2010      
   SUPPLIER PHONE: 555-555-4444                                                 
                                                                                
 SUBMITTED HCPCS: E0570RR   APPROVED HCPCS: E0570RR    INIT DT: 07/29/2005      
   STATUS: CM CLOSED MAINT ONLY     STATUS DT: 10/05/2006       LENGTH: 15      
   TYPE: 1 INITIAL       TOT RENTAL PMTS: 15  RECERT/REVISE DT:                 
   SUPPLIER NAME: DEF MEDICAL SUPPLY           LAST CLAIM DT: 10/29/2007      
   SUPPLIER PHONE: 555-555-3333

Real-Time CSI Claims History Sample Response


 ________                PROVIDER CLAIMS DISPLAY SCREEN                 VMSPI02 
                                                                                
    CARRIER NO:   18003          NPI: 1234567890      PROVIDER NO: 1234560001   
                                                                                
 HICN: 123456789A  NAME: MOUSE                MICKEY     DOB: 01/01/1950 SEX: M 
 CCN: 12345678901000 TOTAL SUBM. CHG:    $295.00  PD PROV:    $185.50           
 CAT: F1 FINALIZED                                       CHK/EFT DT:            
 STAT DT: 10/22/2010 STAT: 3   CLM HAS BEEN ADJUDICATED & IS WAITING PAY CYCLE  
   FROM      TO    PROC CODE       SVC   SUBMITTED  REND PROV PAYTO PROV   LN   
 10/18/10 10/18/10 A7039NUKX        1.0     $25.00 1234560001      $9.43    1   
 LN CTRL NBR: 12345678                                                          
 10/18/10 10/18/10 A7032NUKX        6.0    $270.00 1234560001    $176.07    2   
 LN CTRL NBR: 23456789                                                          
                                                                                
 ________                PROVIDER CLAIMS DISPLAY SCREEN                 VMSPI02 
                                                                                
    CARRIER NO:   18003          NPI: 1234567890      PROVIDER NO: 0987654321   
                                                                                
 HICN: 123456789A  NAME: MOUSE                MICKEY     DOB: 01/01/1950 SEX: M 
 CCN: 12345678902000 TOTAL SUBM. CHG:    $895.00  PD PROV:    $464.12           
 CAT: F1 FINALIZED                                       CHK/EFT DT:            
 STAT DT: 10/22/2010 STAT: 3   CLM HAS BEEN ADJUDICATED & IS WAITING PAY CYCLE  
   FROM      TO    PROC CODE       SVC   SUBMITTED  REND PROV PAYTO PROV   LN   
 10/18/10 10/18/10 E0601RRKHKX      1.0    $185.00 1234560001     $80.88    1   
 LN CTRL NBR: 34567890                                                          
 10/18/10 10/18/10 E0562NUKX        1.0    $325.00 1234560001    $218.08    2   
 LN CTRL NBR: 45678901                                                          
 10/18/10 10/18/10 A7034NUKX        1.0    $250.00 1234560001     $85.17    3   
 LN CTRL NBR: 56789012                                                          
 10/18/10 10/18/10 A7035NUKX        1.0     $45.00 1234560001     $26.87    4   
 LN CTRL NBR: 67890123                                                          
 10/18/10 10/18/10 A7037NUKX        1.0     $45.00 1234560001     $29.70    5   
 LN CTRL NBR: 78901234                                                          
 10/18/10 10/18/10 A7038NUKX        6.0     $45.00 1234560001     $23.42    6   
 LN CTRL NBR: 89012345

Real-Time CSI Pending Claims Detail Sample Response


  OPTION: __              PROVIDER DETAIL PENDING INQUIRY               VMSPP50 
                                 ALL PENDED CLAIMS                              
  NPI: 1234567890   PROVIDER: 1234560001                                        
  BENEFICIARY:                                                                  
  H: 123456789A   NM: MOUSE                MICKEY       DOB: 01/01/1950 SEX: M  
                                                                                
  TOTALS: CLAIMS       2  SUB     1,190.00  PAID       649.62                   
                                                                                
  CLAIM NUMBER    SUBMITTED  PAYTO PROV  277 CD  STAT DATE DESCRIPTION          
  12345678901000     895.00      464.12  F1/3   10/22/2010 CLM ADJ/WAIT PAY CYC 
  98765432110000     295.00      185.50  F1/3   10/22/2010 CLM ADJ/WAIT PAY CYC 
                                                                                
  277 CATEGORY LEGEND: AX - ACKNOWLEDGED  PX - PENDING  FX - FINALIZED

Real-Time CSI Pending Claims Summary Sample Response


   OPTION: __              PROVIDER SUMMARY PENDING INQUIRY              VMSPP40 
                                                                                
  NPI : 1234567890    PROVIDER: 1234560001                                      
                                                                                
                                CLAIMS    SUBMITTED AMOUNT                      
  QUERY SUSPENSE                     28         5,261.00                        
  OTHER SUSPENSE                      4         2,715.00                        
  COMPLETED HELD                     67        14,694.00                        
  TOTAL                              99        22,670.00