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Back  RFI # 2142: 277 valid characters

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Submitter

Louise Smith

Description

In a 277 is a comma a valid character in the claims status code; for example the comma after 232: STC*A3:232,XXX:

Response

STC01-02, the element referenced in the request, is DE 1271, which is an AN type data element. X12.6 identifies that any character in the basic character set (and extended character set, if being used) is valid within an AN type data element. The basic character set does include the comma. From an X12 syntacs perspective, the comma is valid.

For STC01-02, which is used as part of C043 in the STC segment, there is a semantic note that reads "C043-02 is used to identify the status of an entire claim or a service line. Code Source 508 is referenced unless qualified by C043-04". There is also a TR3 note as part of the referenced guide (005010X212) that states "The Status Code is either a Health Care Claim Status Code (Code Source 508) or a National Council for Prescription Drug Programs Reject/Payment Code (Code Source 530)." As a result, the contents of this element must be from the applicable code source in order to comply with the referenced TR3. Since those codes do not contain a comma, sending the comma does not comply with the TR3. The value “232,XXX” is not a value in the external code list.

Recommendation

Looking at the sample that you provided (STC*A3:232,XXX:), it looks like the sender may be trying to send multiple codes within a single element, possibly using the repeat feature of ASC X12. That feature is not applicable to component elements of a composite, and cannot be applied to the Claim Status Code. Multiple Claim Status Codes are sent by also utilizing STC10 and STC11, or by sending multiple iterations of the STC segment, which can occur >1 times within the 277 and TR3 specific implementation.
Submission 4/6/2016
Status Date 6/30/2016
Status F - Final
Primary References
Document 005010X212
Section6.1