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Back  RFI # 2105: STC03 and STC04 in 277CA

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Submitter

Julia Dunicheva

Description

If there are multiple instances of STC segment in loop 2200B, should all of them have the same values in STC03 and STC04 elements?
And the same question for multiple instances of STC segment in loop 2200C.

Response

If multiple STC segments are necessary to explain a summary level status at the 2200B or 2200C, then the STC03 and STC04 elements at those respective levels would repeat the same values.

The 2200B level STC segment is used to provide summary level status on the entire unit of work being acknowledged (i.e. the whole 837, ST-SE). It is not used to provide status on portions of the 837 or individual claims. That means the entire transaction must either be identified as Accepted (STC03=WQ) or Rejected (STC03=U) and all message codes reported in STC01, STC10 and STC11 and/or multiple STC segments at the 2200B level are related to that overall summary status of Accept or Reject. It would be nonsensical to indicate the status of the entire transaction is both accepted and rejected at this level. Additionally, STC04 states 'This will be the sum of all CLM02 values (claim charge) for the claims being acknowledged' at this summary level. As identified by the Implementation Name 'Total Submitted Charges for Unit Work', STC04 represents the total or cumulative dollar amount for this summary level status and not portions or individual claim dollar amounts.

The 2200C level STC Segment is used to provide status of a specific Billing Provider’s group of claims within the 837. It is not used to provide status on portions of any given Billing Providers group of claims or individual claims. When providing status at the 2200C level, the collective group of claims, as a whole, must be either accepted or rejected (STC03). The STC04 is the 'Sum of the Billing Provider claims within the 837 transaction being acknowledged.' It represents the total or cumulative dollar amount for that specific Billing Provider's group of claims and not portions or individual claim dollar amounts.

RFI's 1211 and 1332 provide additional clarification on reporting status at the 2200C level.
Submission 10/26/2015
Status Date 12/15/2015
Status F - Final
Primary References
Document 005010X214
Section2.4
Page52
Set ID277
Loop2200B
Segment IDSTC