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Back  RFI # 876: Entity ID Code for STC in 277

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Submitter

Brian Matthews

Description

While creating front end edits for possible error responses using the 277 Health Care Claim Status Response (005010X212), we have identified what we believe to be a problem with a missing Entity Identifier Code used in STC composite data element.

In the third piece of the Health Care Claim Status composite, STC01-3, found in Loops 2200D, 2220D, 2200E and 2220E of the 277, the Entity Identifier Code (Data Element #98) “PE” is not found. The Entity Code “PE” (Payee) identifies the Pay to Plan entity in the 5010 versions of the 837 Health Care Claim (Institutional, Professional and Dental).

Could you please advise what Entity Identifier Code should be used in the 277 STC01-3 when identifying errors for the Pay to Plan entity in the 277 response?

Submitter Assigned Keywords

277, Pay to Plan, Entity Identifier Code

Response

This issue is not explicitly addressed in the 276/277 Health Care Claim Status Request and Response (005010X212). There is not an Entity code for ‘Pay to Plan’ in the guide. The guide developers will add an Entity code designated for ‘Pay to Plan’ in a future version of the guide.

Recommendation

The Claim Status workgroup recommends using 40 - Receiver to identify the ‘Pay to Plan’ in the 277 Response to a 276. The Pay to Plan loop is used by the Payer submitting the 837 claim for subrogation payment. The ‘Pay to Plan’ would be the Information Receiver in the 276/277 when they are requesting status on a subrogation claim.
Submission 10/6/2009
Status Date 11/20/2009
Status F - Final
Primary References
Document 005010X212
Section2.6
Page139
Set ID277
Table2
Loop2200D
Segment Position1000
Segment IDSTC
Element PositionC0
Component Position43
External Code List98
Code ValuePE