Emdeon Claim Status Codes
When Emdeon receives electronic claims from you, each claim is checked at the clearinghouse for format and syntax errors. If Emdeon identifies an error, the claim is rejected by Emdeon and is NOT sent to Affinity. Emdeon will provide you with a claim status report, listing the error reason for each rejected claim. Click here for the complete list of Emdeon Claim Status Codes.
Affinity Claim Status Codes
If an EDI claim passes the Emdeon clearinghouse edits, it is then forwarded to Affinity. When Affinity receives an 837 claim file from the Emdeon clearinghouse, the claims are checked again for errors. If Affinity identifies errors in a claim, that claim is rejected by Affinity and claim status information is sent to the Emdeon clearinghouse. Emdeon, in turn, will provide you with a claim status report, identifying claims rejected by Affinity. Below are the current claim status codes used by Affinity/Emdeon.
If you are not contracted with Affinity Health Plan and you receive a claim rejection code of “QF7”, please click on the Verification Form link listed to the left.If your practice is contracted with Affinity and you receive a claim rejection code of “QF7”, please click on the NPI Update link listed to the left. If you have already provided NPI data to Affinity Health Plan, please email Provider Relations at: firstname.lastname@example.org.