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Back  RFI # 2113: Usage of Claim Billed Amounts

Formal vs. Informal Help Informal Formal

Submitter

Andrew Lee

Description

A Payer is sending X228 277Us without billed amounts on the claim level. I have called them and asked them to start sending them, but they are refusing, telling me that because the 277 is not a Hipaa Transaction, they are not required to send the billed amounts. I understand that the 277 itself is not a required transaction, but they are indicating a X12 committee approved version by using 005010X228 is the GS Segment. If they use that 277, i would like a determination that they have to have the billed amounts.

Submitter Assigned Keywords

Claim Level Billed Amounts

Response

This issue is explicitly addressed in the 277 Health Care Claim Pending Status Information (005010X228). The 2200D STC04 (Total Claim Charge Amount) is a required element and must be reported. In order to comply with the implementation requirements of the 005010X228 TR3 277 Pending Claim transaction, the 2200D STC04 value is required. Compliance with the TR3 applies, regardless of whether or not the 005010X228 is a mandated transaction under HIPAA.
Submission 11/24/2015
Status Date 1/27/2016
Status F - Final
Primary References
Document 005010X228
Section1.4.3
Page60
Loop2200D
Segment IDSTC