Alex, you're correct about STC04 being required. I sure must have looked at something cross-eyed regarding the situational usage requirement!
I would take the approach that if the total submitted charges amount was received in the AMT segment on the inbound 276 to use that amount on the responding 277. If the AMT segment is not received since it's usage is situational, then using a zero would probably work. Just a word of caution here, though, in that since STC04 is an R datatype some translators will suppress all leading zeros, and thus not send the element at all. You'll need to determine what your translator's capabilities/limitations may be for R datatype elements. Rachel -----Original Message----- From: Alex Chernyak [mailto:[EMAIL PROTECTED]] Sent: Friday, May 03, 2002 9:28 AM To: [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: RE: FW: Total Claim Charge Amount STC04 is required. I am thinking to use a zero since it is allowed and also the incomming claim may be split for many reasons. Thank you for your help >>> "Rachel Foerster" <[EMAIL PROTECTED]> 05/02/02 07:36PM >>> Alex, I'm probably not the definitive authority on this, but my take is that the original submitted charges are what the provider submitted on the original claim. This is all that the provider would have knowledge about and most likely would have no knowledge of any adjustments. This data, along with other data, is sent to the payer on the 276 claim status query such that when combined the payer should be able to identify the claim in question. Additionally, this data would have been received by the payer in the 276 AMT segment. Thus, you would have it to turn around to the requestor. Note also that the STC04 element is marked situational in the 277. Unfortunately, the situation is very well described. Thus, if it were I, I'd either return the value from the AMT segment in the 276 (if received), else not use the STC04 in the 277. Rachel -----Original Message----- From: Alex Chernyak [mailto:[EMAIL PROTECTED]] Sent: Thursday, May 02, 2002 3:28 PM To: [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: Re: FW: Total Claim Charge Amount Rachel, 277 response requires Monetary Amount (Total Claim Charge Amount) and defines it as "the amount of original submitted charges". If the claim was adjusted several times, do we still go back to the very original charge or the amount previous to the last adjustment can be considered as such? We have a purge system in place and the very original claim may be gone (archived). ---------------------------------------------------------------------------- -- CONFIDENTIALITY NOTICE: This message is intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential or exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that you are strictly prohibited from printing, storing, disseminating, distributing or copying this communication. If you have received this communication in error, please notify us immediately by replying to the message and deleting it from your computer. Thank You, Antares Management Solutions. ============================================================================ == ---------------------------------------------------------------------------- -- CONFIDENTIALITY NOTICE: This message is intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential or exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that you are strictly prohibited from printing, storing, disseminating, distributing or copying this communication. If you have received this communication in error, please notify us immediately by replying to the message and deleting it from your computer. Thank You, Antares Management Solutions. ============================================================================ ==
