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Back  RFI # 432: 277 Transaction Rejections

Formal vs. Informal Help Informal Formal

Submitter

Doug Fielding

Description

In the 270/271 transaction set for eligibility there are multiple AAA segments where rejections can happen such as:

Authorized Quantity Exceeded (2000A, Code 04)
Authorization/Access Restrictions (2000A, Code 41)
Unable to Respond at Current Time (2100A, Code 42 or 80)
Provider Ineligible for Inquiries (2100B, Code 50)

The 277 does not have AAA segments. How would these situations be handled in the 277 world?

Submitter Assigned Keywords

276/277 277 AAA

Response

The X12 277 Transaction Standard uses the STC segment to provide status. The transaction standard does not have AAA segments. In the 004010X093 guide, status is reported at the claim loop, and on a situational basis at the service loop, in the appropriate patient (subscriber or dependent) hierarchical level.

For the business situations in question, the response must be repeated for each patient claim status request received in the 276 transaction. Generally the ā€˜Eā€™ type Category Codes with appropriate status code would be utilized.

Recommendation

Code Source 508 (Health Care Claim Status Code) already contains several codes that are appropriate for the business scenarios identified. A few code suggestions, although not limited to these, would be 24 or 109 (with an entity code), 484, 485 and 494. If the codes currently available from Code Source 508 do not meet your business situations, you may request new codes through the on-line conference at the Washington Publishing Company website (www.wpc-edi.com).
Submission 7/25/2006
Status Date 9/8/2006
Status F - Final
Primary References
Document 004010X093A1
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