The Claim Settlement Response File is a batch file in a pipe-delimited format. The file is uploaded daily by InstaMed via SFTP.
To help with file tracking InstaMed is able to deliver a zero byte file on days when there is no data to report.
Record ID: IMCRA10
The response file includes a record of claim payments. Payments will be in one of the following statuses:
- PAID: Payment was disbursed to provider
- SETTLED: Settled payments
- CANCELLED: Cancelled, Reissued or Expired virtual card payments
- RETURNED: Returned payments
- PENDING FUNDING: Payments that are available for approval in InstaMed Online
- SUSPENDED: Suspended payments
- PARTIALLY SETTLED: Partially settled payments
- VOIDED: Voided payments
- EXPIRED: Expired claim payment card payments
- STOPPED: Check has been voided or stopped by the bank
Fields
| Field # | Field Name | Format | Min | Max | Required | Comment |
|---|---|---|---|---|---|---|
| 1 | Record ID | IMCRA10 | 7 | 7 | Y | |
| 2 | ClaimID | AN | 1 | 18 | S | Internal Claim ID REF*9A field |
| 3 | PayerClaimNumber | AN | 1 | 30 | N | CLP07 |
| 4 | ClaimSubmitterIdentifier | AN | 1 | 38 | Y | CLP01 |
| 5 | ClaimCharges | DEC | Y | CLP03 | ||
| 6 | ClaimPayment | DEC | S | CLP04 Available when transaction status is Paid | ||
| 7 | PaymentDate | AN | 8 | 8 | S | YYYYMMDD, Available when transaction status is Paid |
| 8 | DisbursementTraceNumber | AN | 1 | 30 | S | TRN02 Disbursed check/trace number to provider; Available when transaction status is paid |
| 9 | DisbursementEntity | AN | 10 | 42 | S | TRN03:TRN04 Available when transaction status is Paid |
| 10 | OriginalTraceNumber | AN | 1 | 30 | S | From original file TRN02 |
| 11 | FundingEntity | AN | 10 | 42 | S | From original file TRN03:TRN04 |
| 12 | Payer Name | AN | 1 | 35 | Y | N102 when N101 = PR |
| 13 | Payee Last | AN | 1 | 35 | Y | N102 when N101 = PE |
| 14 | Payee First | AN | 1 | 35 | S | |
| 15 | Payee Primary ID Qualifier | AN | 2 | 2 | Y | N103 when N101 = PE |
| 16 | Payee Primary ID | AN | 1 | 80 | Y | N104 when N101 = PE |
| 17 | Patient Last Name | AN | 1 | 35 | Y | NM103 when NM101 = QC |
| 18 | Patient First Name | AN | 1 | 35 | Y | NM104 when NM101 = QC |
| 19 | Patient Middle Name | AN | 1 | 25 | S | NM105 when NM101 = QC |
| 20 | Patient ID Qualifier | AN | 2 | 2 | Y | NM108 when NM101 = QC |
| 21 | Patient ID | AN | 1 | 80 | Y | NM109 when NM101 = QC |
| 22 | Status | AN | 1 | 20 | Y | PAID: Payment was disbursed to provider RETURNED: Returned payment SETTLED: Settled payments CANCELLED: Cancelled, Reissued, or Expired virtual card payments PENDING FUNDING: Payments that are available for approval in InstaMed Online SUSPENDED: Suspended payments PARTIALLY SETTLED: Partially settled payments VOIDED: Voided payments EXPIRED: Expired claim payment card payments STOPPED: A check has been voided or stopped by the bank |
| 23 | Freeform | AN | 1 | 100 | S | |
| 24 | Payment Method | AN | 1 | 30 | Y | ACH, CHK, VirtualCard |
| 25 | Return Code | AN | 3 | 3 | S | Populated when Message Status = Returned |
| 26 | Return Reason | AN | 1 | 100 | S | Populated when Message Status = Returned |