RFI Browser

Back  RFI # 1089: Requests for Additional Info

Formal vs. Informal Help Informal Formal

Submitter

Patrick Sutherland

Description

Since the 5010X212 - 276/277 Implementation Guide restricts further use of the 'R' category codes (Request for Additional Information), is there a recommended alternative for how a Payer would notify a Provider that information is pending due to this missing information?

It would seem that an alternate method would be needed until the 5010X213 - 277 'Request for Additional Information' becomes mandated for usage.

One possible solution might be for the Payer to use a more generic category/status from the remaining codes (i.e. P5 – Pending/Payer Administrative/System hold), with a generic status code (i.e. ’48-Electronic request for information’).

Does this seem appropriate?

Submitter Assigned Keywords

277 Request for Additional Information Status Category Codes

Response

This issue is explicitly addressed in guide 005010X212. Section 1.4.5 states "ASC X12 Health Care Claim Request for Additional information (277), which is a payer's request for additional information to support a health care claim. This function is not supported in this implementation guide."

Section 1.1 states "This implementation guide focuses on the use of the 276 to request the status of a health care claim(s) and the 277 to respond with the information regarding the specified claim(s)."

Therefore, this guide allows you to use Status Category codes in the "P" category to indicate that the claim is pending receipt of additional information, but does not support the "R" codes for requesting that information. The request functionality is a separate implementation as defined in IG 005010X213.
Submission 6/28/2010
Status Date 6/29/2010
Status F - Final
Primary References
Document 005010x212
Section1.3.2.2
Page3
Set ID277