Understanding Substantiation status
My Care Card assigns transactions a substantiation status to indicate whether a transaction is valid, invalid, or in the process of being validated. My Care Card displays the substantiation status on the Member Profile Transactions tab, the Substantiation tab, and the Transaction Substantiation page. Several substantiation phases have stages that indicate how many times a member has been notified and the result of the notification.
The following table explains the substantiation status codes in My Care Card.
Note: Your organization may use customized rules that determine at which substantiation phase or stage notifications are sent and cards become blocked automatically. Cards issued by your organization may be blocked before reaching the stage described in the table below.
|
Status |
Assigned automatically or manually? |
|
Ineligible- Stage 1 |
Manually from Pending or Pending More Info |
|
Ineligible- Stage 2 |
Automatically from Ineligible- Stage 1 |
|
Ineligible- Stage 3 |
Automatically from Ineligible- Stage 2 |
|
Ineligible- Stage 4 |
Automatically from Ineligible- Stage 3 |
|
Ineligible- Plan Reimbursed |
Manually from any Ineligible status |
|
Pending- Stage 1 |
Automatically- My Care Card assigns Pending when a transaction is not substantiated automatically |
|
Pending- Stage 2 |
Automatically from Pending Stage 1 |
|
Pending- Stage 3 |
Automatically from Pending Stage 2 |
|
Pending- Stage 4 |
Automatically from Pending Stage 3 |
|
Pending- Approved Receipt |
Manually from any Pending status stage |
|
Pending More Info- Stage 1 |
Manually- TPA changes any Pending status to |
|
Pending More Info- Stage 2 |
Automatically from Pending More Info 1 |
|
Pending More Info- Stage 3 |
Automatically from Pending More Info 1 |
|
Pending More Info- Stage 4 |
Automatically from Pending More Info- Stage 3 |
|
Pending More Info- Approved Receipt |
Manually from any Pending More Info status stage |