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Back  RFI # 192: Submitted vs Corrected Info

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Submitter

Barbara Sesny

Description

The 277 implementation guide does not indicate whether the patient information (name, contract number, date of birth) returned should be what was submitted or what is in the payer's system.

Response

At the time this implementation guide was drafted, the workgroup’s intent was to leave it to the discretion of the Information Source to determine when it is appropriate to send corrected (changed) data.

Recommendation

It is the recommendation of the authors that in situations where a claim is not found, the patient information that was submitted on the 276 must be returned on the payer’s 277 response.
For claims that are found to be a match, it is at the Information Source’s discretion to determine the data source of the patient information returned on the 277 response (i.e. 276 submitted data or from the Information Source’s system).
Submission 2/4/2005
Status Date 3/16/2005
Status F - Final
Primary References
Document 004010X093A1
Section277
Page152
Set IDNM104
Table2