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Back  RFI # 1648: v3070 U277 bundled w 5010 835

Formal vs. Informal Help Informal Formal

Submitter

Christine Williams

Description

A Medicaid payer is sending back 5010 835’s with unsolicited U277 within the same file (ISA/IEA). The U277 is a 3070 version in a GS/GE labeled as version 3070.

Their companion guide for 5010 does state the following:
Both paid and denied claims will be reported in the 835. Pended claims will be reported in the ASC X12 Health Care Claim Status Notification Transaction Set U277 (unsolicited 277) transaction and will be transmitted in the same envelope (ISA/IEA) as the 835.

There is mention in the 835 TR3 that 277 is used to report non adjudicated claims, however not a u277 and certainly not a 3070 version. Can covered entities "bundle" non 5010 compliant transactions within the same interchange as the 5010 835 Functional Group envelope? This is causing the provider receiving the 5010 835 to not be able to properly process their payments.

Thank you in advance for your assistance.

Submitter Assigned Keywords

U277, 835, remittance

Response

ASC X12 enveloping does allow for multiple versions of transactions within a specific interchage (ISA to IEA). Each Functional Group (GS-GE) must identify a specific version/implementation in GS08. Since the version within the GS08 element is constrained by the definition of the data element as identified within the ASC X12 standard to include only specific values for the version/release/subrelease part of the element (character positions 1 through 6), all Functional Group versions must be either the same version as the interchange envelope, or an older version than the interchange envelope.

One of the code values that make up the first six characters of GS08 in version 005010 is:

"003070 Draft Standards Approved for Publication by ASC X12 Procedures Review Board through October 1996"

Therefore, it is consistent with the ASC X12 standard to include a Functional Group based upon version 003070 within an ISA of version "00501" (ISA12) that also contains a Functional Group where GS08 equals "005010X221A1" (the value for the version 005010 Health Care Claim Payment/Advice (835) transaction).
Submission 8/1/2012
Status Date 10/12/2012
Status F - Final
Primary References
Document 005010X221
Section1.7
Page5