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Back  RFI # 1614: Subscriber not found respose

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Submitter

Robert Lapp

Description

What is the appropriate X212 277 response when the subscriber is not found?

Should this be reported in the STC segment in the provider loop skipping the subscriber loop, or

Should it be reported in the subscriber loop without the STC04 data element?

The STC04 in the subscriber loop is required in v4010A1, but that appears to be corrected in v5010 when it because situational.

Submitter Assigned Keywords

X212 277 5010 SCT04

Response

This issue is explicitly addressed in the 005010X212 TR3, Section 1.4.3.2 Status Response Levels. Status at the 2200C Provider of Service Level is limited to reporting rejected claim status requests for errors related to the provider. A Claim Status response indicating a subscriber is not found must be reported in the 2200D Subscriber Loop in order to identify which specific subscriber and corresponding request was not found.

The 2200D STC04 element is Situational and only required when providing status on a claim that was found in the Information Source’s system. If the subscriber of the request can’t be found, then the claim for which status is being requested is also not found and therefore the STC04 element would not be used.

Recommendation

When rejecting the request for “subscriber not found”, examples of some possible responses returned in the 005010X212 2200D STC segment can be found below:
STC*E0:26:IL*20120617~
STC*E0:33*20120617~

Category Code
E0 = Response not possible - error on submitted request data.
Status Codes
26 = Entity not found. Note: This code requires use of an Entity Code.
33 = Subscriber and subscriber ID not found.
Entity Code
IL = Insured or Subscriber
Submission 6/21/2012
Status Date 8/1/2012
Status F - Final
Primary References
Document 005010X212
Section2.6
Page138
Set ID277
Table2
Loop2200D
Segment IDSTC
Element Position04
Industry NameTotal Claim Charge Amount