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Back  RFI # 1278: 5010 837 Claim & CCN/DCN

Formal vs. Informal Help Informal Formal

Submitter

matthew klischer

Description

In the 4010A1 837i and 837p, there is a 2300 REF (REF01=F8) for the original ICN/DCN. This data can be carried through on the payer-to-payer 837 COB process.

In the 5010 837i and 837p, the 2300 REF (F8) has a TR3 note that says this information is specific to the destination payer in 2010BB. In Medicare's case, that is our COB trading partner.

When Medicare creates the 837i COB or 837p COB transaction, it does not know the COB trading partner's Payer Claim Control Number so it does not populate the 2300 REF (F8). Medicare populates its Payer Claim Control Number in the 2330B REF (F8) on the 837i and 837p COB transactions.

During 5010 testing, Medicare is receiving complaints that it is not passing the original payer control number (ICN/DCN from the original payer) in the 2300 REF (F8) and that its COB trading partners need this data.

Where does the original payer's claim control number get populated in 5010 on an 837i or 837p COB transaction under the payer-to-payer COB model?

Submitter Assigned Keywords

837 COB DCN/CCN

Response

This is addressed in TR3 note 1 in Loop ID 2300 for the Payer Claim Control Number REF Segment. In a payer-to-payer COB relationship, the original payer's ICN/DCN is specific to both payers involved, therefore it is allowable for the originating payer to send the assigned ICN/DCN of the claim that was adjusted on to the next payer.
Submission 3/17/2011
Status Date 8/2/2011
Status F - Final
Primary References
Document 005010X222
Section2
Page196
Set ID837
Loop2300
Segment IDREF
Element PositionF8
Industry NamePayer Claim Control Number
Secondary References
RFI ID 1176
Document 005010X223
Section2
Page166
Set ID837
Table2
Loop2300
Segment IDREF
Element PositionF8
Industry NamePayer Claim control Number