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Back  RFI # 1991: 277CA with multiple 837 ST/SEs

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Submitter

Christopher Gracon

Description

We are trying to determine compliance with the TR3 (005010X214) for when a file of claims is sent where each claim is in its own ST/SE. We are having a 277CA sent back to us which has a ST/SE to match each ST/SE 837 we sent. The issue is what values should be sent in the Loop 2200B STC/QTY/AMT segments. We are seeing the combined total amounts and quantities for all claims sent in each ST/SE of the 277CA. The Loop 2200D STC contains only response(s) corresponding to the claim(s) send in the corresponding ST/SE in the 837.

Is this compliant with the TR3 or should the Loop 2200B STC/QTY/AMT only reflect the claim(s) in the matching ST/SE in the 837?

Submitter Assigned Keywords

277CA

Response

This issue is addressed in the 277 Claim Acknowledgment (277CA) 005010X214 TR3. The 277CA 2200B Loop is used to acknowledge and provide a total accounting of all claims received in a single 837 (ST-SE), not combined totals from multiple 837s.

The following segment and element notes in the 2200B Loop indicate the one to one correlation between the 277CA and the 837(ST-SE) being acknowledged. By association, the QTY and AMT segment totals contained within the 2200B Loop of any given 277CA would also only account for claims from a single, 837 (ST-SE), not combined totals from multiple 837s.

2200B TRN Segment TR3 note - This segment contains the value submitted in the BHT03 data element from the 837.
2200B STC Segment TR3 note - This segment will be used to convey information about an entire unit of work (e.g. single transaction of claims).
2200B STC04 element note - This will be the sum of all CLM02 values (claim charge) for the claims being acknowledged. In most instances, this will be the sum of charges submitted from ST to SE of a single 837 transaction set. (The second element note for the 2200B STC04 clarifies the 'In most instances' statement, which applies to a separated or split single (ST-SE) 837 and not combining totals from multiple 837s.
Submission 11/20/2014
Status Date 2/4/2015
Status F - Final
Primary References
Document 005010X214
Section2
Set ID277CA
Table2
Loop2200B