Should
pre-adjudication claim edits be reported back to health care providers via
an ANSI X12N 277 rather than the X12N 835 remittance transaction?
For example, a provider sends claims electronically using the X12N 837
claim standard to a health plan, the health plan compares the contents of
the X12N 837 to a series of high-level mainframe edits before the claim
enters into adjudication. At this point, claims are either accepted into the
health plan's adjudication system or rejected back to the provider, so that
the claims can be fixed and re-submitted.
9/17/2001:
The Secretary did not adopt a standard for reporting claim edit errors
back to a health care provider. It is the health plan's decision as to
whether it uses the unsolicited X12N 277 to send error messages back to
the health care provider.