Section title: Requests for Interpretation
RFI #
2560
What date should be in the 277 2200D/E STC02?
Description

What date should be in the 277 2200D/E STC02?   In reviewing RFI 1791, the following is noted:

"The Status Information Effective Date (STC02) is a Required element in the Claim (2200D/E) and Service (2220D/E) Level STC Segments.  This element is defined in Appendix E (Data Element Glossary) as ‘The date that the status information is effective.’ In the instance where a ‘claim not found’ status is returned, the STC02 value would be reported as the current system date (i.e., the date the 'claim not found' status was determined). "

What would be the expected date when a finalized claim is found - would it be the current system date (i.e., the date the 'finalized' status was determined) - essentially the date of the transaction - OR would it be the date the claim was finalized?  If so, wouldn't that be redundant with the STC06 (Adjudication Finalized Date)?

Scenario

If claim 1234ABCD for subscriber John Doe was finalized on 5/1/2022, and a 276 request was sent on 5/3/2022, what date would be in the 277 2200D STC02 - 5/3/2022 or 5/1/2022?

RFI Response

The element note for STC02 (Loop 2200D and 2200E) states “This is the date the claim was placed in this status by the Information Source’s adjudication process.” Based on this and the provided Business Scenario, the appropriate date to report in STC02 would be the date the Information Source moved the claim to the status of final adjudication (e.g., 5/1/2022).  As noted, the Information Source’s adjudication process establishes the date the claim was placed in the current status (STC02) as well as the final adjudication date (STC06) and these dates could be the same as per their process.

 

Related RFIs:  1791

DOCUMENT ID
005010X212