Watson Supply Chain Ideas

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Compliance Check App - Consistently create REF(D9) Segment in the 277CA to tie Claim Ack back to the original good/bad 837.

Our organization needs the capability for the HIPAA Pack's Compliance Check application to consistently generate a 277CA (005010X214) with a REF (D9) segment for both good and bad claims so that the 277 Claim Ack may be tied back to the original claim. Our interpretation of the TR3 situational notes in the X214 Implementation Guide is that the REF (D9) segment needs to be created with the REF02 value provided as received in the original 837, and that it shouldn't matter whether the claim was for a patient who is the subscriber or the dependent. The IG states that the 2000D loop is situational. The Compliance Check has been designed for performance reasons not to create the 2000D because it is not required, and that if all claims are accepted, that only the provider level is created and not the patient level. But without the REF02 segment for either subscriber or dependent level claims, we cannot tie the 277CA back to the good or bad claim it is acknowledging.
  • Avatar32.5fb70cce7410889e661286fd7f1897de Guest
  • Jan 9 2018
  • Uncommitted Candidate
How will this idea be used?
What is your industry? Healthcare
What is the idea priority? High
DeveloperWorks ID DW_ID105578
Link to original RFE http://www.ibm.com/developerworks/rfe/execute?use_case=viewRfe&CR_ID=105578
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  • Admin
    Luke Raiano commented
    November 14, 2018 16:10

    We plan to incorporated in a future release