RFI Browser

Back  RFI # 1030: CLM07 Usage

Formal vs. Informal Help Informal Formal

Submitter

Gail Kocher

Description

The reporting requirement for CLM07 is changed from Medicare Assign Indicator to Assign/Participation Indicator for the Destination Payer. Medicare (Med) primary payer claims sent to CMS FIs, A/B MACs, DMACs or RHHIs for reimbursement will continue to utilize this field in the same manner as in 004010: Providers will populate the field based on whether they do or do not accept Med (FFS) Assign. Based on drafts of the CMS COB companion guide (Nov 2009 draft), it is our understanding that CMS will pass on crossover claims the CLM07 field for the 837I as ‘A – Assigned’ and for the 837P according to the provider’s Med assign for the claim.
Payers with Med Advan contracts need to know the Provider’s assign/participation status with Med FFS in order to process the MA claim. In these instances, Providers submit their claims to a Payer with whom the Provider may/ may not be contracted. Can MA Providers populate the CLM07 field with their assignment/participation for Med FFS as in CMS guidelines for Med FFS claims?

Response

CLM07 represents the relationship between the provider and the payer in Loop 2010BB. If Medicare is the payer presented in Loop 2010BB, the provider should use submit the appropriate value to represent the relationship they have with Medicare.
Submission 4/21/2010
Status Date 5/28/2010
Status F - Final
Primary References
Document 005010X223
SectionSection2
Page146
Set ID837I
Table2
Loop2300
Segment Position1300
Segment IDCLM
Element Position07
Industry NameAssignment or Plan Participation Code
Secondary References
RFI ID 937
Document 005010X222
SectionSection2
Page160
Set ID837P
Table2
Loop2300
Segment Position1300
Segment IDCLM
Element Position07
Industry NameAssignment or Plan Participation Code