One business argument of processing a 276 Claim Status Request, and
returning a 277 Claim Status Respond is to reduce customer service calls.
If one returns the minimum 277 Claim Status Codes (Code Source 508) of
0,1,2, then plan on hiring more operators. Who knows, maybe it is more
affordable than other options available, especially for small to mid-size
payers.
>From previous work, the following is a suggestion:
� Query Data Source all records that match the Provider ID, Subscriber ID,
Subscriber Last Name, Dates of Service, Total Charges and first seven
positions of the patient first name.
� If there is only 1 matching record, it is returned on the 277.
� If there are multiple matches, perform the following tie-breaking logic:
- if any records match the claim number provided, return that claim in the
277 response.
- if there is no match on the claim number, then use the patient first name
to match. Use the first 7 characters of the first name as provided in the
276.
- if there are still multiple matches, make a business decision to either
return all related claims Page 11 1.3.2} or return "claim not found" in the
277.
Seg/Elm
Loop Label SegPos Usage M/Mx
Page
2100C PROVIDER IDENTIFIER NM109 R/R AN 2/80
145
2100D SUBSCRIBER LAST NAME NM103 R/R AN 1/35
151
2100D/E SUBSCRIBER FIRST NAME NM104 R/S AN 1/25 151
2100D SUBSCRIBER IDENTIFIER NM109 R/R AN 2/80
152
2200D/E TOTAL CLAIM CHARGE AMOUNT STC04 R/R R 1/18 162
2200D/E CLAIM SERVICE PERIOD DTP03 S/R AN 1/35 172
It could be one's business agreement with trading partners to have these
elements available to return a value-added claim status respond.
Salutations,
Dominic Saroni
www.rfa-edi.com
-----Original Message-----
From: Howeth, Teresa [mailto:[EMAIL PROTECTED]]
Sent: Wednesday, February 13, 2002 4:34 PM
To: '[EMAIL PROTECTED]'
Subject: 276 / 277 Claim Status
As the Payor, we had not been doing EDI at all and went from no EDI to HIPAA
compliant EDI. If a claim status is received and the Insured ID provided is
invalid, do we have to provide the capability to search on names prior to
responding? The reason I ask is because we have a unique number assigned to
each Insured and we are not always provided with the correct Insured ID.
Are we going to be required to accept in the transaction and search on name
to locate the number prior to returning as not our Insured?
I appreciate anyone who can assist.
Thanks,
Teresa Howeth, Business Analyst
DP Admin
[EMAIL PROTECTED]
UICI http://www.uiciinsctr.com
817-255-3338 Office
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