B2B Frequently Asked Questions

General FAQ's
How do I submit an electronic transaction to State Farm?
What versions of transactions are you using?
What does my 997 mean?
What does my 277 Front End Acknowledgement mean?

Eligibility FAQ's
What does reject code “42 – Unavailable to respond at Current Time” mean?
What does reject code “72 – Invalid/Missing Subscriber Insured ID” mean?
What does reject code “75 – Subscriber/Insured Not Found” mean?
What does reject code “77 – Subscriber Found, Insured Not Found” mean?
What does reject code “67 – Patient Not Found” mean?
What does “1 – Active” mean?
What does “6 – Inactive” mean?
What does “7 – Inactive-Pending Eligibility Update” mean?
The response I was given from my Eligibility request provides a remaining deductible amount, but it is not an amount that I expected.
I asked about a past date or a future date. Why did you give me the status with today’s date?
What data do I need to use in the Eligibility request?
I’ve tried several times to send a transaction and each time I get the response “State Farm cannot respond” what does this mean?

Claim Status FAQ's
What does “P1 19 40 – Entity acknowledges receipt” mean?
What does P1 56 – Awaiting eligibility determination” mean?
What does “P2 0 – Cannot provide further status electronically” mean?
What does “P3 110 – Claim requires pricing information” mean?
What does “P3 123 MR – Additional information requested from entity” mean?
What does “F0 26 QC – Entity not found” mean?
What does “F0 54 – Duplicate of previously processed claim/line” mean?
What does “F1 1 – Claim/line has been paid” mean?
What does “F1 2 – Claim/line has been paid” mean?
What does “F3 0 – Cannot provide further status electronically” mean?
What does “F4 1 – No payment due to contract/plan provisions” mean?
What does “F4 2 – No payment due to contract/plan provisions” mean?
What does “A1 0 – Cannot provide further status electronically” mean?
What does “A4 35 – Claim/encounter not found” mean?
What does “E1 484 – Business Application Currently Not Available” mean?
How do I get a State Farm Bill ID?
What is a Bill ID?
Where do I use the Bill ID?
What data do I need to use in the Claim Status request?

Health Care Claim Payment/Advice (ERA)
How do I begin receiving Health claim payments electronically (835 Health Care Claim Payment/Advice transactions) from State Farm?
Why do I need to establish a relationship with a clearinghouse or VAN?
What clearinghouse or Van should I contact?
I have an established relationship with a clearinghouse or VAN other than WebMD Envoy™ or UHIN. Can I use it?
I have established a relationship with WebMD Envoy™, UHIN (when it becomes available to State Farm), or one of their reciprocal partners. What is my next step?
Do I receive both the payment and the remittance advice (Electronic Remittance Advice) through the clearinghouse or VAN?
I received the payment but not the remittance advice (ERA). What do I do?
I received the remittance advice (ERA) but not the payment. What do I do?

General

How do I submit an electronic transaction to State Farm?

• State Farm is only accepting electronic transactions through UHIN, Mutual of Omaha, and WebMD Envoy™. Please view the appropriate transaction link to determine the requirements for submitting that transaction to State Farm.

• Below is the list of versions State Farm is using for the various Health Care Transactions:
• Claim Status Request/Response (276/277) - 4010X093A1
• Dental Claims (837) – 4010X097A1
• Eligibility Benefit Inquiry and Response (270/271) - 4010X092A1
• Institutional Claims (837) – 4010X096A1
• Professional Claims (837) – 4010X098A1
• Remittance Advice (835) – 4010X091A1

• The 997 is a functional acknowledgement. This acknowledgement is sent when the transaction does not meet the X12 industry standards.

• The 277 Front End Acknowledgement shows which claims were accepted or rejected into State Farm’s adjudication system. The 277 Front End Acknowledgement also contains State Farm’s Payer Claim Control Number, also known as State Farm’s Bill ID. The Bill ID should be used in the Claim Status request to ensure an exact match to the claim.

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Eligibility

What does reject code “42 – Unavailable to respond at Current Time” mean?

• This reject code indicates that the Information Source (State Farm) cannot respond due to a problem with our system.
• Our system may be down or inactive. As a result, we return the above reject code.

• This reject code is used if the policy number is not in a valid format, as designated by State Farm.
• Correct syntax: IE (11 positions vs. 12 positions)
• The transaction’s file is received on our end. However, the policy number is not in the correct format, so, we do not process the request in the application. As a result, we return the above reject code.

• This reject code is used when we cannot match the policy number, date of birth, or name sent from a provider.
• The transaction’s file is received on our end. The data contained within the file does not match data that is held in our system. As a result, we return the above reject code.

• This reject code is used for subscriber level requests if the policy number matches with our system, but the date of birth and name do not match to a patient.
• The transaction’s file is received on our end. We have identified a policy number and that this is a subscriber level request. However, the supporting detail does not match any patients or that policy. As a result, we return the above reject code.

• This reject code is used for dependent level requests if the subscriber is found in our system but the patient is not.
• The transaction’s file is received on our end. We have identified a policy number. However, the supporting detail does not match any patients or that policy. As a result, we return the above reject code.

• Policy is in force.

• Policy is not in force

• Policy is either partially processed or pending issuance.

• The deductible is available but is not accumulated. Because of timing of the adjudication of claims from multiple providers, payments, information requests; the accurate calculation of a deductible is difficult to provide.

• At this time our system is designed to show the current status on the day that the request was made.

• The Patient’s State Farm Policy number, Patient’s Date of Birth, and the Patient’s first and last name should be included in an Eligibility request.

• State Farm’s system is down. Please try submitting your Eligibility request again later.

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Claim Status

What does “P1 19 40 – Entity acknowledges receipt” mean?

• State Farm acknowledges the receipt of your claim, but the claim is unassigned and is currently unprocessed.

• The claim is pending eligibility determination.

• The claim is pending an accounting transaction.

• The claim is awaiting an adjustment or a repricing determination from one of State Farm’s repricing vendors.

• The claim is pending additional information requested from the Medical Insurance Carrier.

• The claim has been rejected because the patient was not found within State Farm’s system.

• The claim has been rejected because it is a duplicate of a previously submitted claim.

• The claim/line has been paid. Please see the Electronic Remittance Advice (835) that has been sent to you for more information.

• The claim/line has been paid. Please see the paper Explanation of Benefits that has been sent to you for more information.

• The claim has been closed without payment.

• The claim has been denied. Please see the Electronic Remittance Advice (835) that has been sent to you for more information.

• The claim has been denied. Please see the paper Explanation of Benefits that has been sent to you for more information.

• An exact match on the claim was not found using the information provided in the Claim Status request.

• The claim was not found using the information provided in the Claim Status request.

• State Farm’s business application is currently unavailable. Please try submitting your Claim Status request again later.

• When an electronic claim is accepted by State Farm, it is given a unique identifier, Bill ID (Payer Claim Control Number). The Bill ID sent in the 277 Front End Acknowledgment Transaction.

• A Bill ID is a unique number given to every electronic claim accepted into State Farm’s adjudication system. This is State Farm’s Payer Claim Control Number. The Bill ID should be used in the Claim Status request to ensure an exact match to the claim.

• The Bill ID should be used in the Claim Status request in the REF02 element.

• A Claim Status request should include State Farm’s Bill ID (Payer Claim Control Number). This is the best way to ensure an exact match to a claim. Additional required fields include the Provider’s Tax Identification Number (or UHIN Trading Partner Number), the Policyholder’s State Farm policy number, the total submitted charges on the original claim, and the claim/line service dates.

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Health Care Claim Payment/Advice (ERA)

How do I begin receiving Health claim payments electronically (835 Health Care Claim Payment/Advice transactions) from State Farm?

• You must complete 2 steps:
1. Establish a relationship with a clearinghouse or Value- Added Network (VAN).
2. Enroll in State Farm Electronic Funds Transfer (EFT).

• State Farm transmits all 835 Health Care Claim Payment/Advice transactions through either a clearinghouse or VAN. Therefore, this relationship needs to be established before you can enroll in State Farm Electronic Funds Transfer (EFT).

• As of October 16, 2003, WebMD Envoy ™will be transmitting both 835 and 837 transactions for State Farm. Please contact WebMD Envoy™ at (800) 845-6592.The Utah Health Information Network (UHIN) will also be transmitting both 835 and 837 transactions for State Farm in the near future. They may be contacted at (801) 466 –7705.

• Both WebMD Envoy™ and UHIN have reciprocal arrangements with other clearinghouses and VANs. Please contact your established clearinghouse or VAN directly to determine if it is able to transmit through WebMD Envoy™ or UHIN (when it becomes available to State Farm). If your established clearinghouse or VAN is not able to transmit these transactions through WebMD Envoy™ or UHIN, you will need to establish a relationship with either WebMD Envoy™ or UHIN (when it becomes available to State Farm) in order to receive Health claim payments electronically from State Farm.

• You must complete the State Farm EFT enrollment forms. Click here to go to the EFT Questionnaire for Health Care Providers and the Authorization Agreement

• These will be transmitted in separate channels. The payment will be transmitted electronically through normal banking channels. The Electronic Remittance Advice (ERA) will be transmitted through the clearinghouse or VAN. These will need to be reconciled in your office.

• Since several separate entities are involved in transmitting the ERA, you should start by contacting your clearinghouse or VAN at its support phone number. They will be able to answer your question, contact State Farm for you, or refer you to State Farm for further consideration.

• Since several separate entities are involved in transmitting the payment, you should start by contacting your bank at its support phone number. They will be able to answer your question, contact State Farm for you, or refer you to State Farm for further consideration.