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Medical Associates Health Plan Payer Specific Business Rules

Submitters may send a 276 claim status request on claims filed electronically (via an 837 Health Care Claim) or on paper. MAHP/HC does not distinguish between paper and electronic claims when issuing a 277 response. Date ranges returned on the 277 response (DTP03) are those submitted on the 276 request. The 276 requests that use date ranges for service dates receive all claims within the range, unless other qualifiers, such as claim numbers or amount billed, preclude their return. To avoid unnecessary responses, date ranges should only be used for an inquiry when the date range represents the dates of a single service or claim. MAHP/HC does not support service line specific status requests. When sent, this data will be ignored and the request will be processed using the claim level data.

MAHP/HC provides claim status information at the claim level for both Institutional and Professional claims. MAHP/HC does not support the Dependent loop since all MAHP/HC member are uniquely identified in at the Subscriber Level (loop 2000D) with an 11 digit member number – starting with “R” followed by 10 digits. For the 276 claim status request transaction, the TRN segment is required with the subscriber is the patient – as MAHP/HC considers all patients subscribers for the purposes of HIPAA asthey are uniquely identifiable with an 11 digit member number. The TRN segment received on the 276 claim status transaction will be returned unaltered on the 277 response transaction, except that TRN01 will be changed to “2”.

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