2200B INFORMATION RECEIVER APPLICATION TRACE IDENTIFIER
TR3
PAGE # SEG./ FIELD ID FIELD NAME
Sample Data, TR3 Required Value [R] and
Department Returned Value [DRV] USAGE
49 TRN Information Receiver Application Trace Identifier Required
49 TRN01 Trace Type Code 2 [R] R
49 TRN02 Claim Transaction Batch Number Submitter ID + Julian Date [DRV] R
50 STC Information Receiver Status Information Required
50 STC01 Health Care Claim Status R
50 STC01-1 Health Care Claim Status Category Code A1 R 51 STC01-2 Health Care Claim Status Code 20 R 51 STC02 Status Information Effective Date 20110930 R
52 STC03 Action Code WQ [DRV] R
52 STC04 Total Submitted Charges R
55 QTY Total Accepted Quantity Situational
55 QTY01 Quantity Qualifier 90 [R] R
55 QTY02 Total Accepted Quantity R
56 QTY Total Rejected Quantity Situational
56 QTY01 Quantity Qualifier AA [R] R
56 QTY02 Total Rejected Quantity R
57 AMT Total Accepted Amount Situational
57 AMT01 Amount Qualifier Code YU [R] R
57 AMT02 Total Accepted Amount R
58 AMT Total Rejected Amount Situational
58 AMT01 Amount Qualifier Code YY [R] R
58 AMT02 Total Rejected Amount R
Segment
Count Example EDI Data – 277
Received file submission(s) containing 10 bills for Total Charges of $2000. No bills contained EDI formatting errors.
10 TRN*2*012345611273~
11 STC*A1*20*20110930*WQ*2000~ 12 QTY*90*10~
13 AMT*YU*2000~
Received file submission(s) containing 10 bills for Total Charges of $2000. All bills contained EDI formatting errors.
TRN*2*012345611273~
STC*F2*122*201109301*WQ*2000~ QTY*AA*10~
AMT*YY*2000~
Received file submission(s) containing 10 bills for Total Charges of $2000. Four (4) bills contained EDI formatting errors.
TRN*2*012345611273~
STC*A1*20*20110930*WQ*1200~ STC*F2*122*20110930*WQ*800~ QTY*90*6~
2200B Information Receiver Application Trace Identifier notes
1. TRN01 Trace Type Code: Referenced Transaction Trace Numbers Value: 2
2. TRN02 Claim Transaction Batch Number Value:
• LNI generated number consisting of Submitter ID and Julian Date. 3. STC01 Health Care Claim Status
Reporting considerations:
a. A submitter may submit multiple 837 file submissions throughout the business day prior to LNI’s nightly adjudication cycle.
b. The same submitter may submit both Professional and Institutional 837 file submissions during the business day for processing into LNI’s nightly adjudication cycle.
c. LNI will generate a single 277 Notification from the nightly adjudication cycle as a secondary acknowledgement of bills received from the submitter and formatted into the MIPS for adjudication.
d. At this level, LNI will return the STC Health Care Claim Status to report the following to the submitter: • All bills accepted into MIPS adjudication that will be processed through the MIPS adjudication system. • All bills accepted into MIPS that are identified as Auto-Denied due to EDI formatting errors and
rejected from processing through the MIPS adjudication system.
STC01-1 Health Care Claim Status Category Code: Value: A2 or F2
• Code “A2” returned to indicate bill status as:
Acknowledgment/Acceptance into adjudication system – The claim/encounter has been accepted into the adjudication system (WPC Claim Status Category Code).
• Code “F2” returned to indicate bill status as:
Finalized/Denial – The claim/line has been denied (WPC Claim Status Category Code).
STC01-2 Health Care Claim Status Code Value: 20 or 122
• When STC01-1 equal “A2”
Value will be “20” – Accepted for processing (WPC Claim Status Code). • When STC01-1 equal “F2”,
Value will be “122” – Missing/invalid data prevents payer from processing claim (WPC Claim Status Code). LNI will continue to use CSC 122 and will consider using CSC 21 in the future.
Note: Claim Status Code 122 was stopped on 01/01/2008 and replaced by Claim Status Code “21”.
Claim Status Code “21” – Missing or invalid information. At least one other status code is required to identify the missing or invalid information. CSC “122” is more applicable at this level of the STC detail.
The Health Care Claim Status Category Codes and Health Care Claim Status Codes are maintained by and available from the Washington Publishing Company.
2200B Information Receiver Application Trace Identifier notes continued
4. STC02 Status Information Effective Date: format CCYYMMDD Value:
5. STC03 Action Code Value: WQ
• Code “WQ” – Accept.
Used to indicate the bills in this STC segment are accepted into MIPS for processing.
6. STC04 Total Submitted Charges Value:
• This is the sum total of all 837-CLM02 Claim Charges received. • When STC01-1 equal “A2”
Value is the sum total of all 837-CLM02 Claim Charges of the bills accepted into MIPS for adjudication processing.
• When STC01-1 equal “F2”
Value is the sum total of all 837-CLM02 Claim Charges of the bills Auto-Denied due to EDI formatting errors that are rejected from MIPS adjudication processing.
7. QTY Quantity Information Segment (Accepted and/or Rejected)
In conjunction with the STC Health Care Claim Status segment, this segment is used to report:
• The total number of bills accepted into MIPS adjudication processing for all files received from the submitter. • The total number of bills rejected from MIPS adjudication processing due to EDI formatting errors, for all files
received from the submitter. QTY - Total Accepted Quantity • When STC01-1 equal “A2”
QTY01 Quantity Qualifier: Acknowledged Quantity Value: 90
QTY02 Total Accepted Quantity: Value:
o Value is the Total number (count) of all bills accepted into MIPS adjudication processing. QTY - Total Rejected Quantity
• When STC01-2 equal “F2”
QTY01 Quantity Qualifier: Unacknowledged Quantity Value: AA
QTY02 Total Rejected Quantity: Value:
o Value is the Total number (count) of all bills rejected from MIPS adjudication processing due to EDI formatting errors.
2200B Information Receiver Application Trace Identifier notes continued 8. AMT – Amount Information Segment (Accepted and/or Rejected)
In conjunction with the STC Health Care Claim Status segment, this segment will be used is used to report: • The total dollar amount of bills accepted into MIPS adjudication processing for all files received from the
submitter.
• The total dollar amount of bills rejected from MIPS adjudication processing due to EDI formatting errors, for all files received from the submitter.
AMT - Total Accepted Amount • When STC01-1 equal “A2”
AMT01 Amount Qualifier Code: In Process Value: YU
AMT02 Total Accepted Amount Value:
o Value is the Total dollar amount of all 837-CLM02 Claim Charges for all bills accepted into MIPS adjudication processing for all files received from the submitter.
AMT - Total Rejected Amount • When STC01-2 equal “F2”
AMT01 Amount Qualifier Code: Returned Value: YY
AMT02 Total Rejected Amount Value:
o Value is the Total dollar amount of all 837-CLM02 Claim Charges for all bills rejected from MIPS adjudication processing for all files received from the submitter.