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Back  RFI # 1751: 277CA Entity codes

Formal vs. Informal Help Informal Formal

Submitter

CHERYL KELLY

Description

When trying to crosswalk Claims Status codes to the 277CA 2200D Claim Level STC segment, it was identified that there are no Entity codes that would best fit certain Entity code requirements.
Example:
501 - Entity's State/Province. Note: This code requires use of an Entity Code.
For an 837 Professional scenario for example, if this status is being reported for the 2010AC Pay-to Plan Name N3 and N4 segment, there is no Entity code for Pay-to Plan. The Entity code 'PTP' (Pay-to Plan Name) exists in the X12 Workbook, but not used in the 277CA TR3.

Example #2: If the status is being reported for the 2310E Ambulance Pick-up Location or 2310F Ambulance Drop-off Location, there is no Entity code for Ambulance Location. Would '77' Service Location suffice?

Are there plans to expand the Entity codes in the 277CA TR3 to support the various Loops available within an 837 transaction?

Submitter Assigned Keywords

277CA Entity codes Claims Status codes

Response

Unfortunately the 005010X214 (277CA) developers were unaware of the additional entity code needs identified in your examples during the development of the version 005010 implementation guide. Entities codes PTP – Pay to Plan Name, 45 - Drop-off Location and PW - Pickup Address have all been added to a future version of the 277CA Transaction. The 277CA developers try to monitor 837 development efforts to ensure appropriate entity codes are defined and available to meet editing and status reporting needs.

Recommendation

Example 1 – Since the 2010AC Pay to Plan Loop will only be used for subrogation claims by the submitting Medicaid Plans, it is suggested that Entity Code (41 – Submitter) be used in the 277CA for editing errors related to the 2010AC Pay to Plan Loop data. It may be helpful to your trading partners to identify in your companion guide this business scenario and use of Entity Code 41.

Example 2 – While there are no entity codes defined in the 005010X214 for pick-up and drop-off locations, there are some existing Claim Status Codes that can be used to report data errors related to pick-up and drop-off data.
266 Facility point of origin and destination – ambulance
740 Drop-Off Location
751 Ambulance Pick-up State or Province Code
752 Ambulance Drop-off State or Province Code
Submission 2/12/2013
Status Date 3/29/2013
Status F - Final
Primary References
Document 005010X214
Section2.3
Page81
Set ID277CA
Table2
Loop2200D
Segment Position1000
Segment IDSTC
Element Position01
Component Position3
Industry NameENTITIY IDENTIFIER CODE