277CA Code Explanations/Rejection Solutions
Current as of 01/03/2011 v2
Claim Status Category Codes
When information is given on the 277CA report, it is preceded by a Claim Status Category Code. Claim Status Category Codes indicate the general category of the status. Examples of Claim Status Category Codes are: A1 indicates the claim was received but not necessarily accepted, A6 indicates the claim was rejected for missing information, A7 indicates the claim was rejected and needs additional information, A8 indicates the claim was rejected per relational field in error, etc. A complete list of 5010 Claim Status Category Codes is available at this website http://www.wpc-edi.com/reference/codelists/healthcare/claim-status-category-codes/.
Claim Status Codes
Within each Claim Status Category, Claim Status Codes give more specific information. For example, "500 Entity's Postal/Zip Code. Note: This code requires use of an Entity Code" means the 4-digit extension is missing for a Facility zip code. For a complete list of 5010 Claim Status Codes, click here http://www.wpc-edi.com/reference/codelists/healthcare/claim-status-codes/.
Following is a list of Claim Status Codes which have been reported to Prime Clinical Systems. The list includes further explanations of the error and how to resolve the error in our program. Error codes and solutions are added to this list regularly.
Note: This list is available while working in Intellect by selecting the Help menu option, then selecting News. On the left side of screen, select 5010, 277CA Codes, then Code Explanations/Rejection Solutions. E-mails we have sent in both 2011 and 2012 regarding 5010 are also available from this site by selecting Client Email Notices.
Answer: Intellect: No
OnStaff: Yes
19-Entity acknowledges receipt of claim/encounter. Note: This code requires use of an Entity Code.
PR-
Solution: Indicates an invalid zip code in one of the segments in the electronic claim. Check each screen which has an address for the rejected claim, including: Patient Address, Insured Address, Provider Address, Facility Address, Referring source Address, and Insurance Address. Verify the Zip Code, City, and State fields are all completed. If not, update the Zip Code record. If the City and/or State are missing, the claim will be rejected.
255-Diagnosis code
Solution: Indicates the diagnosis billed is either retired or does not apply to the procedure(s) billed. To resolve this problem:
Intellect (Windows OS): Go to Charges/Modify and click on the [Diagnosis] button to enter the correct Diagnosis code. Move your focus up or down to highlight the invalid diagnosis and press ‘D’ to delete.
OnStaff 2000 (Unix OS): Go to Charge/Modify. With your cursor next to the rejected charge, press the letter ‘A’ and select Diagnosis. Enter the correct Diagnosis. Move your cursor to highlight the invalid diagnosis and press ‘D’ to delete.
306 Detailed description of Service
Example: CPT Code 90999
Solution: Indicates a non-specified procedure code. Certain procedures now require the 'actual' description to be populated in the data file. To resolve this problem:
Intellect (Windows OS): Go to Utility/Procedure/Procedure/Modify and set the <Send Description>field to Y. Verify the procedure description in the body of the procedure record is correct.
OnStaff 2000 (Unix OS):
If the required description for the code you are billing may change – you may need to add multiple different records (using different Panel Codes) for the same Procedure (cpt) code, each with it’s own description.
496 Submitter not approved for electronic claim submissions on behalf of this entity. Note: This code requires use of an Entity Code.
Solution: Claims submitted and rejected 1/3/2012 and 1/4/2012 were rejected erroneously by Palmetto GBA. Codes rejected on these dates should be resubmitted to Palmetto GBA.
500 Entity's Postal/Zip Code. This code requires use of an Entity Code.
Solution: The Facility record is missing the 4-digit zip code extension. Go to Utility/ Facility/Modify. Complete the 9-digit zip code. Be sure you add the City and State. Records missing the City and State will be rejected.
560 Entity's Additional/Secondary Identifier