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Back  RFI # 1130: 837P, I, D CN1 Segment

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Submitter

CHERYL KELLY

Description

837P - 2300/2400 CN1 Segment

Usage: Situational
5010 TR3 note: The developers of this implementation guide note that the CN1 segment is for use only for post-adjudicated claims, which do not meet the definition of a health care claim under HIPAA. Consequently, at the time of this writing, the CN1 segment is for non-HIPAA use only.

Issue: AZ Medicaid has a contractual agreement with our health plans that requires the plans to submit Encounter data (post-adjudicated claims) using the 837 transaction, inclusive of the CN1 segment. For 5010, our Translation software vendor interprets this segment as ‘Not Used’ by HIPAA and therefore, should not be sent. Their interpretation to the note affects a large part of our EDI transactions. What is the final rule on the usage of the CN1 segment?

Submitter Assigned Keywords

CN1 segment

Response

As specified by the Situational Rule and the TR3 Note, the CN1 segment in the Professional Claim is for use only for post-adjudicated claims, such as the plan to plan reporting function presented by the request. The segment is not used other than on post-adjudicated claims. A CN1 segment is valid under guide 005010X222 when submitted for post-adjudicated claims.
Submission 8/12/2010
Status Date 9/20/2010
Status F - Final
Primary References
Document 005010X222
Section2.4
Page186
Set IDHC
Loop2300
Segment Position1600
Segment IDCN1
Industry NameCONTRACT INFORMATION