If a detail status is requested by a trading partner in the 276 request, are payers required to return a detail status in the 277 response? Our claims system often only has header status to report on certain claim types so significant work may be needed to implement detail status responses. Would the detail status only be required when requested or should it be sent regardless of what was requested in the 276?
This issue is addressed in guide 005010X212. Section 1.4.2.2 acknowledges that not all payer systems are capable of providing status at the service level. However, Section 1.4.3.2 states "When service lines within a claim have various statuses (example both pending and finalized), a single status must be reflected at the claim level and the service specific statuses must be reported at the service level (2220D or 2220E)."
Therefore, independent of whether the provider requested status of a specific service, the payer is required to return service specific status when the status of any service in a claim is different in detail than the status of the claim as a whole.