These two APIs are complementary to one another.
Claim Status' main task is to check the status of a claim in the payer’s system. If a provider hasn't received a payer report on a claim, or if they have not received payment, they can run a claim status request to find out the most recent state of that claim. When a claim is paid, the claim status response from the payer provides only basic payment details, and excludes the details such as payer adjustments to the total charge, the patient copays and coinsurance, and other payer adjudication details. It produces a status summary instead of a complete breakdown.
Claim Responses and Reports is a tool to fetch claims information files from your mailbox. You can get your complete claims adjudication results here. The Reports files provide deeper details on the payments for individual Service Lines, the individual amounts the payer agreed on for each, and all other relevant adjudication details.
Updated over 1 year ago