LocationX330 | Health Care Claim Acknowledgment
1.4 Business Usage
ActionAdd Chapter 1
Section 1.4.3.1 STC Composite and Code Use Rules, bullets 2 and 3:

An Entity Code must be identified when the Health Care Claim Status Code or the National Council for Prescription Drug Programs Reject/Payment Code message refers to an Entity. For example the Entity Code '85 - Billing Provider' could be used when Status Code '24 - Entity not approved as an electronic submitter' is used.


An Entity Code may also be identified in conjunction with a Health Care Claim Status code to further clarify the status message when the code does not specifically require its use.
CR 1397Update front matter to clarify usage of the TR3.
LocationX330 | Health Care Claim Acknowledgment
1.4 Business Usage
ActionModify Chapter 1
1.4.3.1 STC Composite and Code Use Rules, bulleted item 4.
CR 1153To clarify intended use.
LocationX330 | Health Care Claim Acknowledgment
1.4 Business Usage
ActionAdd Chapter 1
Section 1.4.3.2 Status Messaging for Real Time Adjudication or Predetermination/Estimation
CR 1037Incorporate Real Time instructions, based on the Real Time TR2) in the 835 and 277CA.
LocationX330 | Health Care Claim Acknowledgment
1.4 Business Usage
ActionModify Chapter 1
Added new Section 1.4.5. Balancing
CR 1497Define balancing requirements for 2200B QTY and AMT to ensure the totals accurately reflect the 277CA data.
LocationX330 | Health Care Claim Acknowledgment
1.5 Business Terminology
ActionAdd Chapter 1
Section 1.5 Business Terminology

Real Time Adjudication - allows providers to submit an electronic claim that is adjudicated in real time and receive a response in real time detailing payment or denial of the rendered service. This capability allows providers to accurately identify and collect member responsibility based on the finalized claim adjudication results.
CR 1037Incorporate Real Time instructions, based on the Real Time TR2) in the 835 and 277CA.
LocationX330 | Health Care Claim Acknowledgment
1.5 Business Terminology
ActionAdd Chapter 1
Section 1.5 Business Terminology

Real Time Predetermination/Estimation - allows providers to submit an electronic claim for a proposed service and receive a response in real time detailing the anticipated payment or denial of the proposed service. The response estimates the payment and member responsibility based on the current point in time and the data submitted for the proposed service. This capability allows providers to identify potential member responsibility and set patient financial expectations prior to a service.
CR 1037Incorporate Real Time instructions, based on the Real Time TR2) in the 835 and 277CA.
LocationX330 | Health Care Claim Acknowledgment
1.5 Business Terminology
ActionAdd Chapter 1
Section 1.5 Business Terminology

Predetermination Status Request

A request for status on a claim that was submitted prior to services being rendered. The predetermination request would include all data necessary to find the predetermination within the payers system, except for date(s) of service. See the 837 TR3 for a definition of a predetermination.
CR 1192Create a definitive method for identifying status requests and responses for pre-determination of benefit claims.
LocationX330 | Health Care Claim Acknowledgment
1.7 Related Transactions
ActionModify Chapter 1
1.7.1 The Claim (837), paragraph 1.

Changed to:
Submitting a claim using the 837 format may initiate the creation of the Health Care Claim Acknowledgment (277CA) transaction. The 277 Health Care Claim Acknowledgment (277CA) is sent after the 837 transaction was "Accepted" or "Accepted with Errors" by the 999 Implementation Acknowledgement. A 277CA will not be sent if the 837 transaction was rejected in the 999.

The 277CA transaction provides confirmation that the receiver has received the claim file and will process or forward the accepted claims on for adjudication. This transaction is instrumental in tracking claim submissions through to payer adjudication.
CR 372Section 1.7.1 should not definitively state that the 837 initiates a 277, as this is not always the case.
LocationX330 | Health Care Claim Acknowledgment
1.10 Data Overview
ActionModify Chapter 1
1.7.1 The Claim (837), paragraph 1.

Changed to:
Submitting a claim using the 837 format may initiate the creation of the Health Care Claim Acknowledgment (277CA) transaction. The 277 Health Care Claim Acknowledgment (277CA) is sent after the 837 transaction was "Accepted" or "Accepted with Errors" by the 999 Implementation Acknowledgement. A 277CA will not be sent if the 837 transaction was rejected in the 999.

The 277CA transaction provides confirmation that the receiver has received the claim file and will process or forward the accepted claims on for adjudication. This transaction is instrumental in tracking claim submissions through to payer adjudication.
CR 372Section 1.7.1 should not definitively state that the 837 initiates a 277, as this is not always the case.
LocationX330 | Health Care Claim Acknowledgment | 277 | 0200
BHT - Beginning of Hierarchical Transaction
ActionAdd Data Element Note
Used to specify the sequential order of HL segments. The HL loops in the data stream must comply with this sequential order. An HL parent loop must be followed by any subordinate child loops prior to commencing a new HL parent loop at the same hierarchical level.
CR 1153To clarify intended use.
LocationX330 | Health Care Claim Acknowledgment | 277 | 0100 | 2000A
HL - Information Source Level
ActionModify Segment Note
TR3 Note Change To: This entity is the decision maker in the business transaction.
CR 1153To clarify intended use.
LocationX330 | Health Care Claim Acknowledgment | 277 | 0100 | 2000A
HL - Information Source Level
ActionModify Data Element Note
Loop ID 2000A/HL01 Element Note

Changed to "The first HL01 within each ST-SE envelope must begin with "1", and be incremented by one each time an HL is used in the transaction. Only numeric values are allowed in HL01."
CR 1109For consistency, consider restricting HL01 to numeric values and requiring that enumeration of HL01 begin with 1 and be incremented by 1 for each iteration.
LocationX330 | Health Care Claim Acknowledgment | 277 | 0500 | 2100A
NM1 - Information Source Name
ActionAdd Data Element Code Value
TU - Third Party Repricing Organization (TPO).
CR 737Add Repricer functionality.
LocationX330 | Health Care Claim Acknowledgment | 277 | 0500 | 2100A
NM1 - Information Source Name
ActionDelete Data Element Code Note
Loop ID 2100A/NM108 Identification Code Qualifier

46 - Electronic Transmitter Identification Number (ETIN)

"This number is used for entities identified in translation software typically called "Trading Partner Profiles". It is used for non-health plan entities."
CR 1563Format code notes consistently.
LocationX330 | Health Care Claim Acknowledgment | 277 | 0100 | 2000B
HL - Information Receiver Level
ActionAdd Data Element Code Note
Loop ID 2000B/HL01

The first HL01 within each ST-SE envelope must begin with "1", and be incremented by one each time an HL is used in the transaction. Only numeric values are allowed in HL01.
CR 1109For consistency, consider restricting HL01 to numeric values and requiring that enumeration of HL01 begin with 1 and be incremented by 1 for each iteration.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1000 | 2200B
STC - Information Receiver Status Information
ActionModify Data Element Situational Rule
STC01-03, STC10-03, STC11-03
Changed to "Required when an entity must be identified to further clarify the status code in this composite data element. If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver."
CR 371Clarify when Claim Status Codes require the transmission of an Entity Code.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1000 | 2200B
STC - Information Receiver Status Information
ActionModify Data Element Situational Rule
STC10 and STC11
Changed to "Required when additional status information is needed. If not required by this implementation guide, do not send."
CR 1153To clarify intended use.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1000 | 2200B
STC - Information Receiver Status Information
ActionAdd Data Element Code Value
PTP - Pay to Plan Name.
CR 378Add Pay to Plan at the Information Receiver level.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1000 | 2200B
STC - Information Receiver Status Information
ActionAdd Data Element Code Value
O4 - Factor.
CR 95The Property & Casualty industry needs the ability to report external entities who purchase accounts receivable assets on behalf of a payer (i.e. Factoring Agent).
LocationX330 | Health Care Claim Acknowledgment | 277 | 1000 | 2200B
STC - Information Receiver Status Information
ActionModify Data Element Code Note
Loop ID 2200B/STC03 Action Code

Code Value: WQ - Accept

Changed to "Use when code value "U" is not used. At least one subordinate HL loop must be reported. Acceptance at this level does not mean all claims have been accepted for processing."
CR 1563Format code notes consistently.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1000 | 2200B
STC - Information Receiver Status Information
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1000 | 2200B
STC - Information Receiver Status Information
ActionAdd Data Element Note
Loop ID 2200B / STC04 (Total Submitted Charges for Unit of Work)

Monetary Amounts returned in this element may exceed 10 characters.
CR 1510Expand the allowed length of DE 782, Monetary Amount, as the total claim or encounter charge amounts in an incoming 837 transaction set sometimes exceed the 10 characters allowed per B.1.1.3.1.2 in Appendix B for the data element.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1210 | 2200B
QTY - Total Accepted Quantity
ActionAdd Segment Note
Shared TR3 Note added to Loop ID 2200B/QTY
For QTY segment balancing, see Section 1.4.5 (Balancing)
CR 1497Define balancing requirements for 2200B QTY and AMT to ensure the totals accurately reflect the 277CA data.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1210 | 2200B
QTY - Total Rejected Quantity
ActionAdd Segment Note
Shared TR3 Note added to Loop ID 2200B/QTY

For QTY segment balancing, see Section 1.4.5 (Balancing)
CR 1497Define balancing requirements for 2200B QTY and AMT to ensure the totals accurately reflect the 277CA data.
LocationX269 | Health Care Claim Acknowldgement
STC - Billing Provider Status Information
ActionDelete Segment
Loop ID 2200C / STC (Billing Provider Status Information)
CR 379Support re association of a 'batch' of provider claims within an 837 to a specific Provider Level status (2200C STC) within the 277CA.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1220 | 2200B
AMT - Total Accepted Amount
ActionAdd Segment Note
Shared TR3 Note added to Loop ID 2200B/AMT

For AMT segment balancing, see Section 1.4.5 (Balancing).
CR 1497Define balancing requirements for 2200B QTY and AMT to ensure the totals accurately reflect the 277CA data.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1220 | 2200B
AMT - Total Accepted Amount
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1220 | 2200B
AMT - Total Accepted Amount
ActionAdd Data Element Note
Loop ID 2200B / AMT02 (Total Accepted Amount)

Monetary Amounts returned in this element may exceed 10 characters.
CR 1510Expand the allowed length of DE 782, Monetary Amount, as the total claim or encounter charge amounts in an incoming 837 transaction set sometimes exceed the 10 characters allowed per B.1.1.3.1.2 in Appendix B for the data element.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1220 | 2200B
AMT - Total Rejected Amount
ActionAdd Segment Note
Shared TR3 Note added to Loop ID 2200B/AMT
For AMT segment balancing, see Section 1.4.5 (Balancing).
CR 1497Define balancing requirements for 2200B QTY and AMT to ensure the totals accurately reflect the 277CA data.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1220 | 2200B
AMT - Total Rejected Amount
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1220 | 2200B
AMT - Total Rejected Amount
ActionAdd Data Element Note
Loop ID 2200B / AMT02 (Total Rejected Amount)

Monetary Amounts returned in this element may exceed 10 characters.
CR 1510Expand the allowed length of DE 782, Monetary Amount, as the total claim or encounter charge amounts in an incoming 837 transaction set sometimes exceed the 10 characters allowed per B.1.1.3.1.2 in Appendix B for the data element.
LocationX330 | Health Care Claim Acknowledgment | 277 | 0100 | 2000C
HL - Billing Provider Level
ActionModify Segment Note
CHANGE TO:
This loop may be used to provide totals and amounts by billing provider or when a secondary provider identifier needs to be reported in the Provider Secondary REF segment.
CR 379Support re association of a 'batch' of provider claims within an 837 to a specific Provider Level status (2200C STC) within the 277CA.
LocationX330 | Health Care Claim Acknowledgment | 277 | 0100 | 2000C
HL - Billing Provider Level
ActionAdd Data Element Code Note
Loop ID 2000C/HL01

The first HL01 within each ST-SE envelope must begin with "1", and be incremented by one each time an HL is used in the transaction. Only numeric values are allowed in HL01.
CR 1109For consistency, consider restricting HL01 to numeric values and requiring that enumeration of HL01 begin with 1 and be incremented by 1 for each iteration.
LocationX330 | Health Care Claim Acknowledgment | 277 | 0500 | 2100C
NM1 - Billing Provider Name
ActionModify Data Element Code Note
NM108 - Identification Code Qualifier

XX - Standard Unique Health Identifier for Health Care Providers (NPI)

Changed to "Use when the provider is in the United States or its territories and is eligible to receive a National Provider Identifier (NPI).
OR
Use when the provider is not in the United States or its territories and has received an NPI."
CR 1563Format code notes consistently.
LocationX330 | Health Care Claim Acknowledgment | 277 | 0900 | 2200C
TRN - Provider of Service Trace Identifier
ActionModify Segment Situational Rule
Changed To:
Required when 2200C Loop is used to provide totals and amounts by billing provider or a secondary provider identifier needs to be reported in the Provider Secondary REF segment. If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver.
CR 379Support re association of a 'batch' of provider claims within an 837 to a specific Provider Level status (2200C STC) within the 277CA.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1210 | 2200C
QTY - Total Accepted Quantity
ActionModify Segment Note
Loop ID 2200C / QTY (Total Accepted Quantity)

Changed to:
The purpose of this segment is to report the total number of claims accepted to the adjudication process by the Information Source for the Billing Provider in this acknowledgment.
CR 1153To clarify intended use.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1210 | 2200C
QTY - Total Accepted Quantity
ActionModify Segment Situational Rule
Changed to "Required when reporting totals for a specific billing provider and at least one claim is accepted. If not required by this implementation guide, do not send."
CR 379Support re association of a 'batch' of provider claims within an 837 to a specific Provider Level status (2200C STC) within the 277CA.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1210 | 2200C
QTY - Total Accepted Quantity
ActionAdd Segment Note
Shared TR3 Note added to Loop ID 2200C/QTY

For QTY segment balancing, see Section 1.4.5 (Balancing)
CR 1497Define balancing requirements for 2200B QTY and AMT to ensure the totals accurately reflect the 277CA data.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1210 | 2200C
QTY - Total Rejected Quantity
ActionModify Segment Situational Rule
Changed to "Required when reporting the number of claims rejected for a specific billing provider. If zero claims are rejected for the billing provider do not send."
CR 379Support re association of a 'batch' of provider claims within an 837 to a specific Provider Level status (2200C STC) within the 277CA.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1210 | 2200C
QTY - Total Rejected Quantity
ActionAdd Segment Note
Shared TR3 Note added to Loop ID 2200C/QTY

For QTY segment balancing, see Section 1.4.5 (Balancing)
CR 1497Define balancing requirements for 2200B QTY and AMT to ensure the totals accurately reflect the 277CA data.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1220 | 2200C
AMT - Total Accepted Amount
ActionModify Segment Situational Rule
Changed to "Required when reporting totals for a specific billing provider and at least one claim is accepted. If not required by this implementation guide, do not send."
CR 379Support re association of a 'batch' of provider claims within an 837 to a specific Provider Level status (2200C STC) within the 277CA.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1220 | 2200C
AMT - Total Accepted Amount
ActionAdd Segment Note
Shared TR3 Note added to Loop ID 2200C/AMT
For AMT segment balancing, see Section 1.4.5 (Balancing).
CR 1497Define balancing requirements for 2200B QTY and AMT to ensure the totals accurately reflect the 277CA data.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1220 | 2200C
AMT - Total Accepted Amount
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1220 | 2200C
AMT - Total Accepted Amount
ActionAdd Data Element Note
Loop ID 2200C / AMT02 (Total Accepted Amount)

Monetary Amounts returned in this element may exceed 10 characters.
CR 1510Expand the allowed length of DE 782, Monetary Amount, as the total claim or encounter charge amounts in an incoming 837 transaction set sometimes exceed the 10 characters allowed per B.1.1.3.1.2 in Appendix B for the data element.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1220 | 2200C
AMT - Total Rejected Amount
ActionModify Segment Situational Rule
Changed to "Required when reporting the number of claims rejected for a specific billing provider. If zero claims are rejected for the billing provider do not send."
CR 379Support re association of a 'batch' of provider claims within an 837 to a specific Provider Level status (2200C STC) within the 277CA.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1220 | 2200C
AMT - Total Rejected Amount
ActionAdd Segment Note
Shared TR3 Note added to Loop ID 2200C/AMT
For AMT segment balancing, see Section 1.4.5 (Balancing).
CR 1497Define balancing requirements for 2200B QTY and AMT to ensure the totals accurately reflect the 277CA data.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1220 | 2200C
AMT - Total Rejected Amount
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1220 | 2200C
AMT - Total Rejected Amount
ActionAdd Data Element Note
Loop ID 2200C / AMT02 (Total Rejected Amount)

Monetary Amounts returned in this element may exceed 10 characters.
CR 1510Expand the allowed length of DE 782, Monetary Amount, as the total claim or encounter charge amounts in an incoming 837 transaction set sometimes exceed the 10 characters allowed per B.1.1.3.1.2 in Appendix B for the data element.
LocationX330 | Health Care Claim Acknowledgment | 277 | 0100 | 2000D
HL - Patient Level
ActionModify Segment Usage
Change Segment Usage to Required.
CR 379Support re association of a 'batch' of provider claims within an 837 to a specific Provider Level status (2200C STC) within the 277CA.
LocationX330 | Health Care Claim Acknowledgment | 277 | 0100 | 2000D
HL - Patient Level
ActionAdd Data Element Code Note
Loop ID 2000D/HL01

The first HL01 within each ST-SE envelope must begin with "1", and be incremented by one each time an HL is used in the transaction. Only numeric values are allowed in HL01.
CR 1109For consistency, consider restricting HL01 to numeric values and requiring that enumeration of HL01 begin with 1 and be incremented by 1 for each iteration.
LocationX330 | Health Care Claim Acknowledgment | 277 | 0500 | 2100D
NM1 - Patient Name
ActionModify Data Element Situational Rule
Changed to "Required when the person has a middle name or initial that is known. If not required by this implementation guide, do not send."
CR 1153To clarify intended use.
LocationX330 | Health Care Claim Acknowledgment | 277 | 0500 | 2100D
NM1 - Patient Name
ActionModify Data Element Usage
Changed NM108 from Required to Situational.
CR 1386Consistency across all guides.
LocationX330 | Health Care Claim Acknowledgment | 277 | 0500 | 2100D
NM1 - Patient Name
ActionModify Data Element Usage
Changed NM109 from Required to Situational.
CR 1386Consistency across all guides.
LocationX330 | Health Care Claim Acknowledgment | 277 | 0500 | 2100D
NM1 - Patient Name
ActionModify Data Element Situational Rule
Loop ID 2100D NM108 Identification Code Qualifier

Changed to "Required when NM109 is used. If not required by this implementation guide, do not send."
CR 1478Remove duplication of situational rules between the element and the code qualifier across the TR3.
LocationX330 | Health Care Claim Acknowledgment | 277 | 0900 | 2200D
TRN - Claim Status Trace Number
ActionModify Data Element Industry Name
Replace the Industry Name 'Patient Control Number' with 'Provider's Assigned Claim Identifier.
CR 1154For consistency across all TR3s.
LocationX330 | Health Care Claim Acknowledgment | 277 | 0900 | 2200D
TRN - Claim Status Trace Number
ActionModify Segment Note
This segment is the Provider's Assigned Claim Identifier submitted in the CLM01 of the 837.
CR 1119Clearly differentiate between Patient Account Number and the Provider Assigned Claim Identifier in the 276 and 277 TR3s.
LocationX330 | Health Care Claim Acknowledgment | 277 | 0900 | 2200D
TRN - Claim Status Trace Number
ActionAdd Data Element Note
The maximum number of characters to be supported for this qualifier is 35. Characters beyond the maximum are not required to be stored or returned by the receiving system.
CR 1119Clearly differentiate between Patient Account Number and the Provider Assigned Claim Identifier in the 276 and 277 TR3s.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1000 | 2200D
STC - Claim Level Status Information
ActionModify Data Element Situational Rule
STC01-03, STC10-03, STC11-03
Changed to "Required when an entity must be identified to further clarify the status code in this composite data element. If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver."
CR 371Clarify when Claim Status Codes require the transmission of an Entity Code.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1000 | 2200D
STC - Claim Level Status Information
ActionModify Data Element Situational Rule
STC10 and STC11
Changed to "Required when additional status information is needed. If not required by this implementation guide, do not send."
CR 1153To clarify intended use.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1000 | 2200D
STC - Claim Level Status Information
ActionModify Data Element Usage
Loop ID 2200D / STC12 (Free-form Message Text)

Changed to NOT USED
CR 1229Data element usage change is required to meet industry needs.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1000 | 2200D
STC - Claim Level Status Information
ActionModify Data Element Code Value
Loop ID 2200D / STC01-03 (Entity Type Code)
Standardized (Added/Removed) Entity Type Codes in STC Segment at Claim and Service Levels.
CR 419STC: Standardize use of the same Entity Codes across the TR3s.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1000 | 2200D
STC - Claim Level Status Information
ActionAdd Data Element Code Value
OOP - Other Operating Physician
CR 952Replace the ZZ qualifier with an explicit qualifier that identifies Other Operating Physician.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1000 | 2200D
STC - Claim Level Status Information
ActionAdd Data Element Code Value
AY - Clearinghouse
CR 1120Support reporting of a clearinghouse entity code in the claim status guides. Support reporting of a clearinghouse entity code in the claim status guides.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1000 | 2200D
STC - Claim Level Status Information
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1000 | 2200D
STC - Claim Level Status Information
ActionAdd Data Element
Loop ID 2200D / STC13 (Predetermination of Benefits Code)
CR 1192Create a definitive method for identifying status requests and responses for pre-determination of benefit claims.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1100 | 2200D
REF - Payer Claim Control Number
ActionModify Segment Situational Rule
Loop ID 2200D REF - Payer Claim Control Number

TO:
Required when Loop ID 2100A NM101 value is PR and the claim has been accepted for adjudication. If not required by this implementation guide, maybe provided at the sender's discretion but cannot be required by the receiver.
CR 1121Requiring the payer claim number to be returned on the 277CA for accepted claims, would allow providers to improve front-end automation and would support downstream processes.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1100 | 2200D
REF - Repriced Claim Number
ActionAdd Segment
Loop ID 2200D REF - Repriced Claim Number
CR 737Add Repricer functionality.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1100 | 2200D
REF - Property & Casualty Claim Number
ActionAdd Segment
Loop ID 2200D REF - Property & Casualty Claim Number
CR 385Support the Property and Casualty industry need for a P&C Claim Number.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1100 | 2200D
REF - EDI Control Number
ActionAdd Segment
Loop ID 2200D REF - EDI Control Number
CR 382Some payers use EDI Control Number when a Payer Claim ID has not been assigned. Add support for this identifier to the 277.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1200 | 2200D
DTP - Service Date
ActionModify Segment Usage
Change usage from Required to Situational.
CR 383Change the usage requirement for the Claim Level Claim Date of Service DTP to situational to support predeterminations.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1200 | 2200D
DTP - Service Date
ActionModify Segment Note
Update Segment Note:
For Institutional claims, it is the statement period in loop 2300 (DTP01=434). For Professional claims this information is derived from the earliest service level dates in loop 2400 (DTP01=472) to the latest service level date. For Dental claims it is the service date at the claim loop 2300 (DTP01=472) or when not reported at Loop 2300, it is derived from the earliest service level date in loop 2400 (DTP01=472) to the latest service level date.
CR 383Change the usage requirement for the Claim Level Claim Date of Service DTP to situational to support predeterminations.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1200 | 2200D
DTP - Service Date
ActionModify Segment Situational Rule
Update Situational Rule to:
Required when the claim is not a predetermination and service level dates are not reported. If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver.
CR 383Change the usage requirement for the Claim Level Claim Date of Service DTP to situational to support predeterminations.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1200 | 2200D
DTP - Date of Illness/Injury/Accident
ActionAdd Segment
Loop ID 2200D DTP - DATE OF ILLNESS/INJURY/ACCIDENT
CR 387277 Response: Support the Property and Casualty industry need for Corrected Date of Illness and Date of Accident.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1800 | 2220D
SVC - Service Line Information
ActionAdd Data Element Situational Rule
"Required if submitted on the original claim service line. If not required by this implementation guide, do not send."
CR 384Revise the SVC01 as necessary to accommodate more than 4 modifiers.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1800 | 2220D
SVC - Service Line Information
ActionDelete Data Element Code Value
Loop ID 2220D/SVC01-01

WK - Advanced Billing Concepts (ABC) Codes
CR 749Remove support for Advanced Billing Concept Codes (ABC) across the TR3s as HHS has discontinued the associated pilot project.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1800 | 2220D
SVC - Service Line Information
ActionAdd Data Element Note
SVC07 Original Units of Service Count

The maximum length for this field is 8 digits excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is three. A zero or negative value is not allowed.
CR 1410Negative values are being submitted in the Claim Status Amount and Service Unit data elements of the Claim Status transactions where they do not make business sense. Such negative values should be disallowed.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1800 | 2220D
SVC - Service Line Information
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1800 | 2220D
SVC - Service Line Information
ActionModify Data Element Code Note
HC (Healthcare Common Procedure Coding System (HCPCS) Codes)

Changed to:
Use when reporting HCPCS or CPT codes. AMA's CPT codes are level 1 HCPCS codes, they are reported with an HC qualifier.
CR 1542Improve the consistency of the code value notes within and across the TR3s.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1900 | 2220D
STC - Service Line Status Information
ActionModify Data Element Situational Rule
STC01-03, STC10-03, STC11-03
Changed to "Required when an entity must be identified to further clarify the status code in this composite data element. If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver."
CR 371Clarify when Claim Status Codes require the transmission of an Entity Code.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1900 | 2220D
STC - Service Line Status Information
ActionModify Data Element Situational Rule
STC10 and STC11
Changed to "Required when additional status information is needed. If not required by this implementation guide, do not send."
CR 1153To clarify intended use.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1900 | 2220D
STC - Service Line Status Information
ActionModify Data Element Usage
STC12 Changed to Not Used.
CR 1229Data element usage change is required to meet industry needs.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1900 | 2220D
STC - Service Line Status Information
ActionModify Data Element Code Value
Loop ID 2220D / STC01-03 (Entity Type Code)
Standardized (Added/Removed) Entity Type Codes in STC Segment at Claim and Service Levels.
CR 419STC: Standardize use of the same Entity Codes across the TR3s.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1900 | 2220D
STC - Service Line Status Information
ActionAdd Data Element Code Value
O4 - Factor.
CR 95The Property & Casualty industry needs the ability to report external entities who purchase accounts receivable assets on behalf of a payer (i.e. Factoring Agent).
LocationX330 | Health Care Claim Acknowledgment | 277 | 1900 | 2220D
STC - Service Line Status Information
ActionAdd Data Element Code Value
OOP - Other Operating Physician
CR 952Replace the ZZ qualifier with an explicit qualifier that identifies Other Operating Physician.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1900 | 2220D
STC - Service Line Status Information
ActionAdd Data Element Code Value
AY - Clearinghouse
CR 1120Support reporting of a clearinghouse entity code in the claim status guides. Support reporting of a clearinghouse entity code in the claim status guides.
LocationX330 | Health Care Claim Acknowledgment | 277 | 1900 | 2220D
STC - Service Line Status Information
ActionAdd Data Element
Loop ID 2220D / STC13 (Service Line Predetermination of Benefits Code)
CR 1192Create a definitive method for identifying status requests and responses for pre-determination of benefit claims.
LocationX330 | Health Care Claim Acknowledgment | 277 | 2000 | 2220D
REF - Line Item Control Number
ActionAdd Segment Situational Rule
Required when a Service Line Item Control Number was submitted on the claim. If not required by this implementation guide, do not send.
CR 394Make a decision on the usage requirement for the Line Item Control Number (required or situational) and apply the decision consistently across the TR3s.
LocationX330 | Health Care Claim Acknowledgment | 277 | 2000 | 2220D
REF - Line Item Control Number
ActionModify Segment Name
From: Service Line Item Identification

Changed to:
Line Item Control Number
CR 1539Modify the 2000A REF segment situational rule and the segment name in 275, 276 and 277 guides.
LocationX330 | Health Care Claim Acknowledgment | 277 | 2000 | 2220D
REF - Pharmacy Prescription Number
ActionAdd Data Element Note
This is the Pharmacy Prescription Number submitted in the 2410 REF02 from the 837 claim.
CR 1153To clarify intended use.
LocationX330 | Health Care Claim Acknowledgment | 277 | 2100 | 2220D
DTP - Service Date
ActionAdd Segment Situational Rule
Required when a service level date was submitted on the claim for this service. If not required by this implementation guide, do not send.
CR 395The Service Line Date of Service is always required, however institutional lines can be reported without a date of service.
LocationX330 | Health Care Claim Acknowledgment | 277 | 2150 | 2220D
TOO - Tooth Information
ActionAdd Segment
Loop ID 2220D
TOO - TOOTH INFORMATION
CR 1516For consistency across guides.