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Back  RFI # 133: USE CLP06 TO FLAG ADMIN. CLMS?

Formal vs. Informal Help Informal Formal

Submitter

Henry Greene

Description

INDIANA MEDICAID HAS 2 PGMS THAT ARE CAT. AS "ADMINISTRATIVE" AND THE CLAIMS FOR THESE 2 PGMS NEED TO BE FLAGGED SOMEHOW ON THE 835. WE WERE THINKING OF USING 'OF' IN CLP06 INSTEAD OF 'MC'. THIS MAKES SENSE, SINCE THE RECIP'S FOR THESE 2 PGMS MAY OR MAY NOT BE ALREADY MEDICAID ELIGIBILE AND BECAUSE THE 2 PGMS ARE FUNDED SEPARATELY FROM MEDICAID AT A DIFFERENT LEVEL (FFP) BY THE FEDS. WILL 'OF' IN CLP06 WORK, OR IS THERE A BETTER/INDUSTRY-WIDE SOLUTION?

Response

This is a business issue rather than a request for interpretation. The provider needs to receive adequate information to qualify the accuracy of the payment. CLP06 must be used in conjunction with the REF on page 128 of guide X091. Qualifier CE in REF01 identifies the class of contract code which will uniquely identify the applicable contract. Details have been shared by phone with the submitter.
Submission 11/10/2004
Status Date 11/10/2004
Status F - Final
Primary References
Document 004010X091
Section3
Page92
Set ID835
Loop2100
Segment IDCLP
Element Position06