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Back  RFI # 867: 277CA Total Submitted Charges

Formal vs. Informal Help Informal Formal

Submitter

Diana Sokolowski

Description

Within the 5010 guide (pg 52, loop 2200B, element STC04), the note dictates 'This will be the sum of all CLM02 values (claim charge) for the claims being acknowledged. In most instances, this will be the sum of charges submitted from ST to SE of a single 837 transaction set.' We currently receive 837 transactions, and then split them into two or three files for processing by internal / external adjudication systems. Based upon this note, must we (option A) wait for status' on ALL claims BEFORE responding with a 277CA, OR (option B) may we immediately respond with a 277CA, which includes any claims for which we have immediate status ? Option B would dictated responding with additional 277CAs, until a status has been reported for ALL claims received within the original 837. Please let me know. Thanx...

Submitter Assigned Keywords

277CA

Response

This issue is explicitly addressed in the 277 Healthcare Claim Acknowledgment Guide, 005010X214. The 277 Claim Acknowledgement is to provide a total accounting of all claims received in a single 837. However, the second note associated with STC04 recognizes there are situations when the original 837 is separated for further processing and in those situations, the corresponding 277 Claim Acknowledgment 2200B STC04 element would be the sum of all claims being acknowledged at that time.
Submission 9/24/2009
Status Date 11/20/2009
Status F - Final
Primary References
Document 005010X214
Section2200B
Page52
Set ID277CA
Loop2200B
Segment IDSTC
Element Position04