277 Claim Acknowledgement definition
277 Claim Acknowledgement transaction is used by some payer organizations usually for accepted and rejected 837 claims. They are intended to be used in version 5010 to replace proprietary error reporting. The 277 Claim Acknowledgement will be sent for each accepted or rejected transaction and will contain a claim number. This approach allows the return of individual claims instead of the entire transaction set when an error is not a syntactic structure issue.
The 277 Claim Acknowledgement reports data problems that must be addressed by resources in the billing area. Billing staff will likely need reports to be produced using the 277 Claim Acknowledgement transaction in order to identify claim corrections before resubmitting.
The key element for providing the status notification is the STC segment which consists of Claim Status categories Claim Status Codes and monetary amounts. Some example codes are:
• A0 – Acknowledgement/Forwarded-The claim has been forwarded to another entity. Used in cases where a third-party (e.g., a re-PRICER) is passing the claim onto the destination payer.
• A1 – Acknowledgement/Receipt-The claim has been received. This does not mean that the claim has been accepted for adjudication.
• A2 – Acknowledgement/ Accepted claim has been accepted into the adjudication system.
• A3 Acknowledgement/Returned as un-processable claim. The claim has been rejected and has not been entered into the adjudication system.
• A5 – Acknowledgement/Split Claim-The claim has been split upon acceptance into the adjudication system.
• A6 Acknowledgement/Rejected for Missing Information – The claim is missing the information specified in the Status details and has been rejected.
• A7 Acknowledgement/Rejected for Invalid Information – The claim has invalid information as specified in the status details and has been rejected.
• A8 – Acknowledgement/ Rejected for relational filed in error
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