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Back  RFI # 1212: 277 NM1/TRN realtionship

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Submitter

Janice Cunningham

Description

Payers are returning TRN and STC segments for multiple claims associated with same NM1*QC segment.
The 276 contained only one TRN segment associated with one NM1*QC segment.
Is it compliant for the payer combine multiple TRN/STC segments for multiple claims with one NM1*QC when the 276 was sent as a one for one?
Additional information can provided if necssary.

Submitter Assigned Keywords

TRN

Response

Yes, the 277 Response may contain multiple responses (2200D or 2200E TRN/STC) related to a single 276 2200D/E (TRN) request. This issue is addressed in both the 004010X093 (Section 1.3.2) and 005010X212 (Sections 1.3.2.1 -Real Time Limitations and 1.4) guides. This scenario occurs when the payer cannot uniquely identify the requested claim within their system based on the data submitted and/or the search criteria used; therefore the 277 response may include multiple claims that meet the parameters supplied by the requester.
When multiple responses are returned, the 277 Response TRN segment(s) must contain the same value as submitted in the associated 276 Request so that re-association of the request to the response can occur. See Sections 2.2.3.5.1 - 004010X093 and 1.4.2.1 - 005010X212 for information on the 2200D/E TRN.
Submission 12/22/2010
Status Date 2/7/2011
Status F - Final
Primary References
Document 004010x093
Section277
Page157
Set IDTRN