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Back  RFI # 803: Status Today vs. Full History

Formal vs. Informal Help Informal Formal

Submitter

Mary Lou jackson

Description

We at the Washington State Healthcare Forum are in the process of writing a Best Practice Requirements for this transaction to comply with some new state regulations. We have both providers and payers at the table and we have two areas in which we cannot come to an agreement. It would be very helpful if you could share the intent of the authors so we can make a decision on our recommendations.

When a provider sends in a request for status on a particular claim they are expecting to see the status of the claim as it exists in the payers system today. In some instances they are receiving every status the claim has hit since the original claim entered the payer system. Providers are complaining this extra data is causing them a lot of problems when loading it into their practice management systems. So our question is, what really is the authors intent on the amount and type of data that should be returned, today's status or the entire history of the claim?

Submitter Assigned Keywords

277 Claim Status

Response

This issue is explicitly addressed in guide 004010X093. Section 1.3.2 states "The payer uses the 277 Health Care Claim Status Response to transmit the current status within the adjudication process to the requester." Therefore, the intent of the 277 is to provide the current status and not the entire history of the claim.
Submission 6/17/2009
Status Date 6/18/2009
Status F - Final
Primary References
Document 4010X093
Section2.2.2
Page17
Set IDSTC