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Back  RFI # 1379: Accept Assignment CLM 07

Formal vs. Informal Help Informal Formal

Submitter

Carter Christine

Description

I would like to know the official interpretation for Loop 2300 CLM 07 Provider Accepts Accpts Assignement Code. How should this element be completed for payers that we do not have contracts with.

What is the rule for this element. If we say yes to accept assignment and there is an underpayment does that mean we are not able to request the remaining reimbursement from the payer?

Submitter Assigned Keywords

accept assignment CLM 07

Response

A value of C – Not Assigned should be used when the provider does not accept assignment or does not have a participation agreement with the destination payer.

Questions regarding underpayments and the assignment reported on an individual claim would need to be discussed between the individual parties involved. X12N WG2 cannot provide guidance on these type of reimbursement issues.
Submission 8/11/2011
Status Date 9/14/2011
Status F - Final
Primary References
Document 005010X223
Section2.4
Page146
Loop2300
Segment PositionCLM07
Segment IDCLM
Element Position07