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Back  RFI # 310: STC deductible reporting

Formal vs. Informal Help Informal Formal

Submitter

Barbara Sesny

Description

When returning a 277 response for a claim where the entire amount was applied to the patient's deductible, should we report CHK or NON in STC07? Technically we approved the claim for payment, but zero dollars were paid. Should we report a check date and number if this claim remittance was included in the provider's voucher?

Response

The 004010X093 guide, Loop 2200 STC07, STC08 and STC09 element notes and terminology create usage contradictions, which consequently do not reflect the full business function intent of those values. The business intent of the STC07, STC08 and STC09 values is to tie the finalized claim 'payment' information back to the remittance advice (paper or electronic) on which the finalized claim was initially reported, enabling the provider to resolve any payment issues they have with the claim.

Recommendation

Based on the intended business function of STC07, STC08 and STC09, it is appropriate to report CHK in STC07 and the check date and check number in STC08 and STC09, respectively, when a zero paid claim is included on a remittance advice that resulted in a check being issued. Alternately if the remittance advice resulted in no payment being issued, then NON would be the appropriate value for STC07. This will provide greater payment tracking information to the provider for subsequent research, review and claim status resolution. In the current guide under development, these values will be tied to the remittance advice (electronic or paper) on which the finalized claim was initially reported to the provider.
Submission 8/16/2005
Status Date 12/6/2005
Status F - Final
Primary References
Document 004010X093A1
Section3
Page163
Set ID277
Table2
Loop2200D
Segment IDSTC
Element Position07