Last Modified: 4/6/2019
Location: FL, PR, USVI
Business: Part A, Part B
Within the ASC X12N 999 (health care claims acknowledgment) transaction, there are CTX segments that were not present in the 997 transaction. The CTX segment that will be present most often will be the Business Unit Identifier CTX and it will identify the patient account number of the claim causing an error. The Segment (and Element) Context CTX segments will provide the event context that resulted in an error.
The Business Unit Identifier CTX will occur when the error being reported back within the 999 occurred in or below the claim level. This segment will be reported within the 2110 loop of the 999, appearing below the IK3 segment and will contain the patient control number of the claim in error. Below is a breakdown of the Business Unit Identifier CTX segment.
• CTX01:1 will always contain ‘CLM01’
• CTX01:2 is the patient control number (CLM01 from the 837) of the claim in error
The Segment Context and Element Context CTX segments identify the situational requirement that triggered the error reported in either the IK3 (segment level) or IK4 (element level). The ‘context’ CTX segments will only be returned on a select few edits that are triggered by either the presence or the absence of situational data. Below is a breakdown of the ‘context’ CTX segment.
• CTX01 will always contain ‘SITUATIONAL TRIGGER’
• CTX02 is the segment name that established the situation causing the error reported in IK3 or IK4
• CTX03 is the line number on which the segment in CTX02 appears
• CTX04 is the loop containing the segment (segment named in CTX02)
• CTX05 is the element number within the segment (segment named in CTX02)
Below is an example 999 containing both a Segment Context CTX and a Business Unit Identifier CTX:
IK3*DTP*45*2300*I6~(DTP segment was missing from line 45 of the claim)
CTX*SITUATIONAL TRIGGER*CLM*24*2300*11:1~(Segment Context CTX: CLM11:1 in the 2300 loop on line 24 contained an auto accident indicator)
CTX*CLM01:CLAIMNUM12345~(Business Unit Identifier CTX: patient control number of the claim in error is CLAIMNUM12345)
Explanation of the 999 example
• The electronic claim indicates that the services are related to an automobile accident (CLM11:1 contains AA)
• Claim is missing the accident date (DTP segment).
• Since the accident date is required when the claim is related to an automobile accident, the 999 generated by this electronic claim will contain a ‘context’ CTX segment.
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