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Status Under review
Created by Guest
Created on Apr 30, 2024

ITX 277CA Processing

Allow for detection of syntactical error in claim by STC0101, and also including an Entity code so that resultant 277CA is valid per use of the STC0102 value of 19:

At each HL level in the 277, there could be rejected claim(s) due to invalid syntax in the 837 Transactions being validated per the 5010 TR3. It is not currently within the functionality of the compliance_check map to track specific error detail within the summary information used to generate the 277CA, so we will need to use a status code and entity codes that are generic to the HL level in which the error occurred - Submitter, Billing provider, Patient/Service. Any more detailed status reported would require an enhancement request, and could impact the overall performance of compliance checking. Also, it must be stressed that other checks outside the scope of compliance checking of syntax such as business

rules based on coverage could affect the final status codes returned in an 277CA to the submitter. It is expected that there is additional processing outside of the ITX compliance checking that would be needed to generate a final 277CA.

This would impact the following 277CA loops


2200B - Information Receiver - If STC03=U, or STC03=WQ and QTY*AA

(Total rejected) is present, then STC01 will be reported as A3:19:41.

If STC03=WQ=WQ and QTY*AA is absent, the STC01 will be reported as


Loop 2200C - Billing Provider -If STC03=U, or

STC03=WQ and QTY*QC (Total rejected) is present, then STC01 will be

reported as A3:19:85. If STC03=WQ and QTY*QC is absent, the STC01 will

be reported as STC*A1:19:85

Loop 2200D - Patient Detail - If

STC03=U then STC01 will be reported as A3:19:QC. If STC03=WQ, STC01

will be reported as STC*A1:19:QC

Loop 2220D - Service Detail - If STC03=U then STC01 will be reported as A3:19:QC. (Loop only present if service in errors)

What is your industry? Healthcare
How will this idea be used?

Improve information returned in claims process to the submitter of a claim