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Back  RFI # 2121: Structure on 277 Response/276

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Submitter

Kim Perry

Description

If a single ST/SE is received on a 276, for the response 277 shouldn't all of the responses be returned within a single ST/SE?

There is a situation where we send multiple request in a batch 276 within a single ST/SE, and the 277 response returned contains multiple ST/SE's and we were expecting the 277 to contain only 1 ST/SE not multiple.

Could not find any reference in the 276/277 TR3 guide for this situation. We did find similar reference in the 270/271 TR3, section 1.4.4 ‘The corresponding 271 response follows the same structure displayed above, with the Eligibility or Benefit Information replacing the Eligibility or Benefit Inquiry’.

Submitter Assigned Keywords

Structure, 276, 277

Response

In batch mode, there is no requirement within the 005010X212 that the 277 Response (ST-SE) must be a 1 to 1 correlation to the 276 Request (ST-SE), except when the 277 Response is being used to reject the entire 276 transaction at the 2200B Information Receiver level. In that situation, there must be a 1 to 1 correlation between the 276 (ST-SE) and the 277 (ST-SE). See Section 1.4.3.2 Status Response Levels -Loop 2200B - Information Receiver and Loop 2200B TRN (TRN02).

In real-time mode, the 277 Response (ST-SE) must also be a 1 to 1 correlation to the 276 Request (ST-SE). See Sections 1.3.1 Batch and Real-time Usage and 1.3.2.1 Real Time and Batch Transmissions (Real Time Limitations).

The reference in Section 1.4.4 of the 270/271 (005010X279A1) pertains to or depicts the Hierarchical Structures and where the Eligibility or Benefit Inquiry and Eligibility or Benefit Information fall within the 270 and 271 transactions. It is not a requirement that the 271 (ST-SE) must contain all of the same data or be a 1-1 correlation to a 270 (ST-SE), particularly in batch mode. See 00501X279A1 Section 1.4.6.2 - Batch Linkage where it states in part, 'Given the nature of batch processing which may or may not respond to each of the requests in the same batch response…'

Recommendation

While it may be favorable for a 276 (ST-SE) with multiple claim status requests to be responded to with a single 277 (ST-SE) that provides claim status responses for all of the claim status requests, it may not always be possible due to the nature of batch processing. To ensure a claim status response is received for each claim status request, the most important tracking mechanism is the 2200D and 2200E TRN (Claim Status Tracking Number).
Submission 1/28/2016
Status Date 3/24/2016
Status F - Final
Primary References
Document 005010X212
Section1.4
Set ID277