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Back  RFI # 1790: 277-STC04 & SVC07

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Submitter

Ward Lori

Description

When a 837 is adjusted or voided and a claim status is requested, MMIS is reporting a negative unit and amount in the STC segment.
When the xml is translated it fails EDI in compliance because a negative amount is not allowed. The IG states it would be the original submitted charge, but some payers may not store this value.

1. Is a negative amount allowed in the STC04 and STC05?
2. Can a unit be passed as a negative (-1, -2 etc...) value in the SVC07?

Submitter Assigned Keywords

277 STC04 STC05 SVC07 negative amounts units

Response

Neither STC04 nor STC05 should be reported as negative values in the 005010X212 (276/277). STC04 is defined as the original submitted charge, which per the 837 guide ‘must be greater than or equal to zero’. Even on paper claims, a provider would not submit a negative claim charge. The NOTE about not storing the original charge is meant to recognize and allow payers to report a different claim charge amount in the case where a claim has been split for processing and the total submitted charge has been changed. The STC05 is defined as the amount paid. A payment can’t be a negative value, but it could be zero for a rejected claim or a claim that was adjusted for a refund. The same monetary reporting principles would hold true for the service level charge and paid amounts in SVC02 and SVC03, respectively.

SVC07 is defined as the original submitted units of service and as such would not be reported as a negative number because a provider would not submit less than zero service units.

Recommendation

While the 276/277 TR3 does not specifically define how a payer should report status on claims that have been adjusted or voided, the guide does state in Section 1.4 Business Usage that ‘current status’ is to be reported. The TR3’s intent of ‘current status’ equates to the ‘end result’ of an adjusted or voided claim. Claim Status Category Code ‘F3 - Finalized/Revised - Adjudication information has been changed’ can be used by the payer to identify the claim has been adjusted. If the adjustment resulted in the claim being voided or refunded, the payer should try to report a Status Reason Code (ex. 27 - Policy canceled) that explains the adjudication change. At a bare minimum, Status Code ‘1 - For more detailed information, see remittance advice’ could be used since the 835 (or paper remittance) would hold the full details of the actual adjudication change (Reversal and Correction).
Submission 5/14/2013
Status Date 6/24/2013
Status F - Final
Primary References
Document 005010X212
SectionTable 2
Page138
Table2
Loop2200D
Segment IDSTC
Element Position04