RFI Browser

Back  RFI # 1290: CRC03 duplicate indicator

Formal vs. Informal Help Informal Formal

Submitter

Steve Drake

Description

Clearinghouse is rejecting claim due to duplicate condition indicator. Error message from clearinghouse reads, "Duplicate condition indicator. Value of CRC03 has been already used. Condition indicator codes are expected to be unique for every CRC segment."

Loop 2400

CR5*I*99*********84*S
CRC*11*Y*37*38*P1
CRC*11*N*38*ZV

The patient mangement system Medisoft's manufacture McKesson corporation believes that having 38 on the first CRC segment and again on the second CRC segment is valid. On the other hand. Edifecs engine users like our clearinghouse maintains that using 38 again in the second line is incorrect. When we tested and sent the same thing thru the clearinghouse engine without 38 on the first CRC line and only in the second, it went thru, but does not accurately report the CMNs oxygen claim for this practice apparently. Please give us feedback.

Thanks,

Steve Drake
Tetridyn Solutions
McKesson Vendor

Submitter Assigned Keywords

CRC03 CRC CMN CMNs oxygen Blue Cross Clearinghouse Edifecs McKesson 37 38

Response

It is not logical for the same condition value (CRC03 - 07) to be send in two CRC segments where one states that the condition does apply (CRC02=Y) and the other that indicates that the condition does not apply (CRC02=N). However, there is no requirement in the 004010X098A1 Implementation Guide that the Condition Indicator code can only be reported in one CRC. The absense of a restriction in the implementation guide does not prevent the receiver from applying additional business and reasonability logic and take appropriate action, which may be to reject the claim.
Submission 4/1/2011
Status Date 6/1/2011
Status F - Final
Primary References
Document 4010X098A1
SectionCMNs
Page432
Set ID837P
Loop2400
Segment PositionCRC
Segment ID03
Element Position03