RFI Browser

Back  RFI # 2203: 277CA: non-rejecting issues

Formal vs. Informal Help Informal Formal

Submitter

Julia Dunicheva

Description

What issues can be reported on 277CA in STC segment: only ones that lead to rejection of transaction/claim? or also issues that are reported as some type of warnings only and do not necessarily lead to rejection of transaction/claim?

Response

The 277CA - 005010X214 has the functionality to report status of either accepted or rejected in the STC Segments. It does not have the functionality to report 'warnings' that did not lead to a rejected status.

The STC03 (Action Code) in the STC segments at all levels except the 2220D, allows for indication of Accept (WQ) or Reject (U). At the 2220D Service level, the STC03 element only allows for Reject (U). Additionally, the 2220D SVC Segment Situational Rule states 'Required when a service line is being rejected and caused the rejection of a claim'. Consequently there is no code to report an 'accepted with errors or warning' status.

The 277CA uses only the Acknowledgment Category Codes (A0 - A8) and Error Category Codes (E1 - E4) in the STC Segments to provide status. The Error Category is limited to real-time use and system unavailable. Within the Acknowledgment Category, the code values which indicate a claim or service data issue (A3, A6, A7, & A8) all included in the description that it means rejected. There are no Category Codes that signify 'accepted with a warning'.

Recommendation

If you have a business need not supported in a published TR3, you may submit an X12 change request for consideration in a future version of the TR3. Change requests are submitted at http://changerequest.x12.org/.
Submission 3/9/2017
Status Date 4/25/2017
Status F - Final
Primary References
Document 005010X214
Section1.4.2
Set ID277