18.4.136 QBP^E03 - Query HealthCare Services Invoice Status (event E03) (16.3.3)

This message is used to query the status of a HealthCare Services Invoice. There are 3 types of queries handled by this message: 1) a specific Invoice, 2) a specific Product/Service Group or 3) a specific Product/Service Line Item. If a Provider wants to obtain information on a group of invoices (e.g., submitted in a date range), each individual Invoice must be queried.

This message may also be used to query an Invoice submitted at another Network Application ID and Network Facility ID, as long as sufficient identification information is provided to qualify the request and requestor. These are noted as Processing Rules for this message.

Note that the response to this query has the same content as an EHC^E10 - Edit/Adjudication Results message.

Processing Rules:

• The Provider Application and the Payer Application must uniquely identify each Invoice, Product/Service Group, Product/Service Line Item and Adjustment. These numbers appear as a pair on the IVC, PSG, PSL and ADJ segments and must be echoed on any subsequent interactions for the Invoice, group or line item between the Provider Application and Payer Application.

• The Provider Application and/or Payer Application may also supply a tracking number for each Product/Service Line Item it processes, specified as the Provider Tracking Number or Payer Tracking Number.The Provider Tracking Number and Payer Tracking Number must be echoed on any subsequent interactions for the Product/Service Line Item between the Provider Application and Payer Application.

• A unique query identifier (Query Tag on QPD) must be generated for each query.Provider Invoice Number + Payer Invoice Number + Product/Service Line Item Number on input message must exist on Payer Application's database and must point to the same Product/Service Line Item, otherwise an error must be generated (mismatched Invoice and/or Product/Service Line Item).

• To query an Invoice, the following fields must be supplied and must match the original Invoice submitted:QPD.Sending OrganizationQPD.Provider OrganizationQPD.Invoice AmountQPD.Provider Invoice NumberQPD.Payer Invoice NumberQPD.Payee Identification List

• To query a Product/Service Group within an Invoice, the following fields must be supplied and must match the original Invoice submitted:QPD.Sending OrganizationQPD.Provider OrganizationQPD.Invoice AmountQPD.Provider Invoice NumberQPD.Payer Invoice NumberQPD.Payee Identification ListQPD.Provider Product/Service Group NumberQPD.Payer Product/Service Group Number

• To query a Product/Service Line Item within an Invoice, the following fields must be supplied and must match the original Invoice submitted:QPD.Sending OrganizationQPD.Provider OrganizationQPD.Invoice AmountQPD.Provider Invoice NumberQPD.Payer Invoice NumberQPD.Payee Identification ListQPD.Provider Product/Service Group NumberQPD.Payer Product/Service Group NumberQPD.Provider Product/Service Line Item NumberQPD.Payer Product/Service Line Item Number