In the 277 response, the STC09 situational rule requires the reporting of STC09 when the remittance cycle is complete, and this claim is included on a check or EFT that is reported in an 835 or paper remittance to the provider.
How should the statement "and this claim is included on a check or EFT that is reported in the 835 or paper remittance to the provider" be applied when the 277 response is for a "denied" claim?
Is a denied claim considered included on a check or EFT if there is no payment tied to the claim?
For a claim that was originally paid and later denied during reprocessing (reversal/correction), is the reprocessed denied claim considered included on a check or EFT?
STC09 also includes an element note that states this could include a non-payment remittance advice Trace Number (835 or paper) if available from the information source's system.
In cases where the remittance does not result in a check or EFT due to a BPR02 amount of 0, must the 277 response include the remittance advice Trace Number if it is available within the information source's system to be in compliance with the TR3?
Scenario 1:
A finalized denied claim is included as one of the claims reported in an 835 where a check or EFT has been issued (BPR02 is greater than zero). If a 276 is received for the "denied" claim, must the 277 response include the check or EFT number to be in compliance with the TR3?
Scenario 2:
A claim was originally processed and paid in the amount of $50. The claim is later reprocessed (reversal/correction) and the correction results in a denial. If a 276 is received for the "denied" corrected claim, must the 277 response include the check or EFT number to be in compliance with the TR3?
Scenario 3:
A finalized paid claim is included as one of the claims reported in an 835 where a check or EFT has not been issued (BPR02 is zero) and the remittance advice Trace Number is available within the information source’s system. If a 276 is received for the claim, must the 277 response include the remittance advice Trace Number to be in compliance with the TR3?
If the claim has been reported on an 835 and the 835 included a check/EFT number, then the check/EFT number should be included on the 277, regardless of the paid amount of the claim being reported.
If the 835 did not include a payment (BPR02=0), then the check/EFT number would not need to be included on the 277 Status response, as a check was not issued.
If the remittance cycle has not been completed, the check/EFT number would not be required.