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Back  RFI # 1382: 277- Usage of STC10 and STC11

Formal vs. Informal Help Informal Formal

Submitter

Amrita Kalkura

Description

I have couple of questions regarding the use of STC10 and STC11 and its value.

1. Is it ok to use STC10/STC11 at claim level when STC segment is used at service line level?

2. If it is ok to use them at both the locations, should STC10/STC11 at both the locations be different?

Thanks!

Submitter Assigned Keywords

STC claim service

Response

Use of STC10 and STC11 in both the Claim level and Service level is allowable within the Claim Status Transactions. STC10 and STC11 are used within the STC segment to provide additional status codes and/or enhance the status message when appropriate. Claim Level Status is always required, even when reporting status at the service level. When reporting multiple statuses, payers must use discretion in choosing the appropriate Category and Status Codes to ensure business compatibility between the status messages reflected. (See Section 1.4.3.1)

If Status Codes are used in STC10 and STC11 at the claim and service levels it is expected that they would be different. Service Level Status is reported when the service line status varies per line or is different from the overall claim status. When service lines within a claim have various statuses (example both pending and finalized) a single status (i.e. Status Category Code) must be reflected at the claim and the service specific status must be reported at the service level. (See Section 1.4.3.2)
Submission 8/15/2011
Status Date 9/27/2011
Status F - Final
Primary References
Document 005010x212
Section1.4.3.2
Page14
Set ID277
Table2
Loop2200
Segment IDSTC