A claim contains errors in the 999 and the IK501 error code is “E”. Per RFI 1927, the entire file should continue on for further processing, which may not result in adjudication. The payer’s clearinghouse is stating that because the claim contained an error on the 999 that the claim is rejected, and they are not including the claim in the file being forwarded. It is not included in their 277CA, or the payer’s 999 and 277CA.
Question 1 – Is having an error on the 999 enough to reject a claim at that point if the IK501 is an “E”?
Question 2 – If the payer’s clearinghouse is not going to reject the entire file (IK501 = “R”), should the claim containing errors continue on in the process and produce a rejection on the 277CA instead?
Question 3 – Can or should syntactical issues that derive from the 999 still be addressed in the 277CA as well?
In response to your first question, "Is having an error on the 999 enough to reject a claim at that point if the IK501 is an “E”? No, the value of "E" in IK501 is not rejecting a claim. It is accepting an entire transaction set which includes errors.
In response to your second question, "If the payer’s clearinghouse is not going to reject the entire file (IK501 = “R”), should the claim containing errors continue on in the process and produce a rejection on the 277CA instead?
Further Discussion:
A File is not a concept in X12 nomenclature. A physical file may contain more than one ISA/IEA structure. This response is based on transaction sets which is the purview of IK5.
In response to your third question, "Can or should syntactical issues that derive from the 999 still be addressed in the 277CA as well?
The 277CA cannot report syntax issues. It can reject a claim for the syntax issues previously identified in the 999 that was accepted with errors. Specifically, Claim Status Code 684 would be used in the 277CA for each claim rejected for the syntax errors reported in the 999 where the IK501 code "E" was reported.
Claim Status Code 684 definition is currently "Rejected. Syntax error noted for this claim/service/inquiry. See Functional or Implementation Acknowledgment for details. (Note: Only for use to reject claims or status requests in transactions that were 'accepted with errors' on a 997 or 999 Acknowledgment.)".
In responding to this RFI, we assume that all claims within the ST-SE (transaction set) to which the 999 is responding with the "E" can later be responded to with a 277CA acknowledgment transaction. An error in the 837 that precludes creation of a valid 277CA requires rejection in the 999, meaning that the 999 must be modified from an "E" to an "R".
Yes, the entire transaction set must continue to be processed when the receiver is creating the 277CA. If the receiver is creating a 277CA, all each claim in the transaction set must be either be accepted or rejected.