HIPAA Compliant 837 Claim Audit (SummaCare)
When the HIPAA Compliant 837 claims file is submitted it is checked for ASC X12 syntax and HIPAA compliance errors. When the compliance check is complete, a 997 Acknowledgement will be sent to the trading partner informing them if the file has been accepted or rejected.
If multiple transaction sets (ST-SE) are sent within a functional group (GS-GE), the entire functional group (GS-GE) will be rejected when an ASC X12 or HIPAA compliance error is found.
Once the HIPAA Compliant 837 claims file is submitted into claims processing system, a 277CA will be sent back to the Trading Partner (along with the 997) that submitted the claim file to SummaCare. The purpose of the 277CA Acknowledgement is to report the status of the interchange envelope for the 837 transaction that you submitted. This acknowledgement can either be accepted or rejected depending on whether the envelope was accepted or rejected.
An accepted acknowledgement occurs when the envelope is set up correctly. A rejected acknowledgement occurs when the envelope is set up incorrectly or the information in the envelope does not match the information that is contained within claims processing system.
The 277CA will advise you of accepted and rejected claims. Review the rejected claims, correct the errors, and resubmit the 837, then the claims associated with this transaction will not be processed and therefore will not be considered for payment. Both the 277CA and 997 will be sent the day following the receipt of the 837 Institutional Health Care Claim file.