277CA transaction example and description
The purpose of the 277CA (Claims Acknowledgement) transaction is to provide a claim level acknowledgement of all claims received in the pre-processing system before submitting claims into a payer’s adjudication system. It is believed that most payers are using the 277CA as their standardized reporting mechanism for 5010. The 277CA transaction is not required by HIPAA. Vendors may offer a method for a more readable acknowledgement. The 277CA transaction is not designed to be read in the original ASC X12 format. To understand more about the 277CA you can refer to the TR3 (Implementation Guide).
277CA transaction example
The sender of this 277CA is Clearing House Inc, the receiver is Agile Billing Solutions and the Billing Provider is Dr. John Watson.
Claim Submission Date: January 24, 2012;
Claim Processing Date: January 24, 2012;
Number of Claim: 1
Total Charges: $65.00.
This 837 Claim File was Rejected.
The reference identification in BHT-03 matches BHT-03 sent in the original 837.
ST*277*0001*005010X214
BHT*0085*08*004545*20120124*1635*TH
HL*1**20*1
NM1*AY*2*BCBS DISNEY*****46*47198
TRN*1*234234
DTP*050*D8*20120124
DTP*009*D8*20120124
HL*2*1*21*1
NM1*41*2*AGILE BILLING SOLUTIONS*****46*1981
TRN*2*2002020542857
STC*A7:23*20120124*U*65
QTY*AA*1
AMT*YY*65
HL*3*2*19*0
NM1*85*1*WATSON*JOHN*H***XX*1134125736
TRN*1*WATSON789
STC*A8:496:85**U*65
QTY*QC*1
AMT*YY*65
SE*22*0001
277CA human readable
Beginning of Hierarchical Transaction: BHT*0085*08*004545*20120124*1635*TH
Hierarchical Structure Code : Information Source, Information Receiver, Provider of Service, Patient
Transaction Set Purpose Code : Status
Reference Identification : 004545
Date : 1/24/2012
Time : 4:35:00 PM
Transaction Type Code : Receipt Acknowledgment Advice
Individual or Organizational Name: NM1*AY*2*BCBS DISNEY*****46*47198
Entity Identifier Code : Clearinghouse
Entity Type Qualifier : Non-Person Entity
Name Last or Organization Name : BCBS DISNEY
Identification Code Qualifier : Electronic Transmitter Identification Number (ETIN)
Identification Code : 47198
Trace: TRN*1*234234
Trace Type Code : Current Transaction Trace Numbers
Reference Identification : 234234
Date or Time or Period: DTP*050*D8*20120124
Date/Time Qualifier : Received
Date Time Period Format Qualifier : Date Expressed in Format CCYYMMDD
Date Time Period : 20120124
Date or Time or Period: DTP*009*D8*20120124
Date/Time Qualifier : Process
Date Time Period Format Qualifier : Date Expressed in Format CCYYMMDD
Date Time Period : 20120124
Individual or Organizational Name: NM1*41*2*AGILE BILLING SOLUTIONS*****46*1981
Entity Identifier Code : Submitter
Entity Type Qualifier : Non-Person Entity
Name Last or Organization Name : AGILE BILLING SOLUTIONS
Identification Code Qualifier : Electronic Transmitter Identification Number (ETIN)
Identification Code : 1981
Trace: TRN*2*2002020542857
Trace Type Code : Referenced Transaction Trace Numbers
Reference Identification : 2002020542857
Status Information: STC*A7:23*20120124*U*65
STC01-01 = Claim Status Category Code ‘A7’ for Ack/Rejected for Invalid Information
STC01-02 = Claim Status Code ‘23’ for ‘Returned To Entity’
STC02 = Status Information Effective Date
STC03 = Action Code ‘U’ for ‘Rejected’
Quantity Information: QTY*AA*1
Quantity Qualifier : Unacknowledged Quantity
Quantity : 1
________________________________________
Returned : 65 AMT*YY*65
Individual or Organizational Name: NM1*85*1*WATSON*JOHN*H***XX*1134125736
Entity Identifier Code : Billing Provider
Entity Type Qualifier : Person
Name Last or Organization Name : WATSON
Name First : JOHN
Name Middle : H
Identification Code Qualifier : Centers for Medicare and Medicaid Services National Provider Identifier
Identification Code : 1134125736
Trace:
Trace Type Code : Current Transaction Trace Numbers
Reference Identification : WATSON789
Status Information: STC*A8:496:85**U*65
STC01-01 = Claim Status Category Code ‘A8’ for ‘Ack/Rejected’ for ‘Relational Field in Error’
STC01-02 = Claim Status Code ‘496’ for ‘Submitter not approved for electronic claim submissions on behalf of this entity’
STC01-03 = Entity Identifier Code ‘85’ for ‘Billing Provider’
STC02 = Status Information Effective Date
STC03 = Action Code ‘U’ for ‘Rejected’
STC04 = Monetary Amount equals Sum of all CML02 elements in the original 837
Quantity Information: QTY*QC*1
Quantity Qualifier : Quantity Disapproved
Quantity : 1
277CA accepted transaction
HL*3*2*19*1
NM1*85*1*JONES*HARRY*B**MD*FI*234567894
HL*4*3*PT
NM1*QC*1*POPPINS*MARY****MI*2222222222
TRN*2*PATIENT22222
STC*A2:20:PR*20060221*WQ*100
STC01-01 = Claim Status Category Code ‘A2’ for Acknowledgement/Acceptance into adjudication system-The claim/encounter has been accepted into the adjudication system.
STC01-02 = ‘20’ Claim Status ’20’ for Accepted for processing.
STC01-03 = ‘PR’ Entity Identifier Code ‘PR’ for Payer
REF*1K*220216359803X Payer’s Claim Number
DTP*472*RD8*20060214 Service Date