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Back  RFI # 1060: 4010 837 Prov gets 5010 835

Formal vs. Informal Help Informal Formal

Submitter

Jan Klimper

Description

If a provider submits a 4010 837, but are receiving a 5010 835, are we required to follow the 5010 TR3 rules for inclusion of original claim data? Specifically, those that differ between 4010 and 5010? Ex: Patient name. System adjudicates based on patient name in database and returns this name in the database on the 835. They do not capture the corrected name to populate on the 5010 835.

Submitter Assigned Keywords

4010 837 5010 835

Response

Independent of the version of the original claim, creation of an 835 that identifies the implementation version as this guide (GS08="005010X221") must be consistent with the instructions in this guide in all ways, including returning of information from the original claim.
Submission 5/26/2010
Status Date 6/8/2010
Status F - Final
Primary References
Document 005010X221
SectionNM1
Page137
Set IDQC
Loop2100
Segment PositionNote