In our experience, analyzing 277 Claim Acknowledgements (the response to your 837 submission) can be a game changer.
Starting in EDI 5010, mandated in healthcare by the government in 2013, an updated response transaction to your 837 submissions became available that listed claim issues called pre-adjudication (upfront) rejections. This feature allowed claims to be rejected upfront, before wasting time and resources going through payer adjudication and eventually showing up on the 835 remittance weeks later.
IT IS CRITICAL to be aware of these pre-adjudication rejections since they are listed ONLY on the 277CA and nowhere else.
For example, you submit 100 claims to the clearinghouse or direct to payer. In pre-adjudication processing 3 claims are rejected upfront and appear on the 277CA generated in response. Meanwhile 97 claims go on to payer adjudication and eventually appear on the 835 remittance.
IF YOU ARE NOT AWARE of this upfront rejection response list, the 3 claims tend to "disappear" from any other payer records. You never see a reconciliation of the 3 claims and they most likely will be re-processed and sent again (and will again appear on 277CA). After a few attempts at submission, you may well run into timely filling issues, where the chance for the claims to be paid are severely reduced and eventually unable to ever be paid.
Being able to analyze the 277CA and make corrections to claims with common errors that would otherwise be "lost" is a game changer.
Our 277CA Analyzer solution gives you access to this invaluable information
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