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Formal vs. Informal Help Informal Formal

Submitter

Dawn Bezio

Description

There is confusion for the usage of the STC segments in the following loops 2200C loop and also the 2200D and 2220D loops.
First the 2200C level states that you can reject a group of provider claims. Can you explain how this would look in a 277CA that was returned with multiple provider claims? I am concerned that payers will not return claim information of rejected claims if they reject at the provider level.

Also confused if we see a line level rejection at the 2220 level does this mean that the entire claim was rejected and the line level data at the 2220 loop is just for information or does it mean that only that line level rejected and the rest of the claim was processed?

Response

The purpose of the 2200C level status is to reject a 'group of claims' for a specific Billing Provider reported within an 837. If the 277CA 2200B (Information Receiver) Loop is equal to Accepted (see 2000C Situational Rule), then for each 2000A Billing Provider Loop reported in an 837, a corresponding 277CA 2000C Loop would be reported. The guide author's intent of the provider level status (2200C Loop within each 2000C Loop) is to report provider level errors that caused that specific provider's group of claims to be rejected (See 2000C HL04=0 note). It is not intended to be used for reporting a culmination of claim specific rejection statuses. Claim specific rejections must be reported in the 2000D Patient level. See Section 3.4 (Business Scenario 4) for a reporting example.

Response continued in Recommendation section:

Recommendation

Continued Response:
2220D Service level data is only reported when a specific service line caused the claim to be rejected. Service Line data is not reported when the claim is being accepted into adjudication. See the 2220D SVC Situational Rule (a service line is being rejected AND caused the rejection of the claim) and TR3 Note 1 (Not used if the claim is being accepted).
Submission 12/22/2010
Status Date 2/7/2011
Status F - Final
Primary References
Document 005010x214
Section277CA
Page80
Set IDSTC