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Back  RFI # 2145: 277CA Receiver Level Rejection

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Submitter

Andrew Lee

Description

For the last year and a half, a payer has been sending 277CA's with Receiver Level Rejections, thinking they are for specific claims.

We would send a file with lets say 10 claims and 2 claims reject. They will send back 10 277CA's, one for each claim, and the claims that have a rejection, they will send in the 2200B loop, an STC02=U. Mind you the other 8 claims are accepted.

In our 837, all 10 claims are in a single ST-SE loop, and GS-GE loop. I would like a determination that sending a rejection in this fashion when they are only rejecting a few claims out of the batch is improper.

Response

This issue is specifically addressed in the 277 Claim Acknowledgment (277CA) 005010X214 TR3. There is a 1 to 1 correlation between an 837 and 277CA that must be maintained for re-association purposes between the two transactions. Additionally, the 277CA 2200B Loop is used to provide an overall status on the 837 transaction being acknowledged and total accounting of ALL claims received in a single 837 (ST-SE). The 2200B STC is not to be used in lieu of providing 2200D Level claim status for each claim received in the corresponding 837.

The following references in the 005010X214 indicate the one to one correlation between the 277CA and the 837(ST-SE) being acknowledged:

Section 1.7.1, The Claim (837) - indicates the 277CA confirms the actions taken on all claims received in the 837 file.

2200B TRN Segment TR3 note - 'This segment contains the value submitted in the BHT03 data element from the 837.' Using the same 837 BHT03 value for multiple 277CAs makes accurate re-association of the 277CA to 837 difficult.

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).

The use of 2200B STC03 value 'U - Reject' is specifically limited to situations 'when the entire claim transaction (837 ST-SE) is rejected due to submitter level errors.' Some examples of submitter level errors are defined within the 2200B STC TR3 note. A submitter level error pertaining to the entire 837 transaction (ST-SE) does not equate to claim level status for each claim within the 837 transaction being acknowledged. If the entire 837 is not being rejected for submitter level errors, then STC03 of the 2200B Loop MUST equal 'WQ - Accept' and the 2000C Billing Provider HL MUST be reported. Subsequently, if the 2000C Billing Provider HL is not being used to report provider specific rejections that apply to all claims for a given provider (HL04=0, STC03=U), then the 2200C Loop, STC03 MUST equal 'WQ - Accept' and the 2000D Patient HL and 2200D Claim Status MUST be reported to acknowledge (accept or reject) each claim received in the corresponding 837.
Submission 5/2/2016
Status Date 6/27/2016
Status F - Final
Primary References
Document 005010X214
Section1.1
Page52
Loop2200B
Segment IDSTC
Element Position3
Industry NameAction Code