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Back  RFI # 1383: CLP09 Situational Rule

Formal vs. Informal Help Informal Formal

Submitter

stacey alsdurf

Description

The situational rule for CLP09 says "Required when the information was received on the original claim. If not required by this implementation guide, may be provided at the sender's discretion, but cannot be required by the receiver."

The corresponding CLP09 value (Claim Frequency Type Code) on the 837D, 837P, and 837I is CLM05-3. Data element CLM05 on all three claim transaction is required as well as CLM05-3. Since the information would be received on the original claim by virtue of the required usage, wouldn't it be considered a HIPAA syntax error for an 835 transaction with 837D, 837P, and 837I claims if there was not a value in CLP09 when responding to those 837 transactions?

Response

The 835 is not limited to responding to claims received in an 837 format. For example, it may be generated as a response to a claim received on paper. Therefore, an edit could only be applied if the receiver of the 835 has explicit knowledge of what was in the claim when received by the sender of the 835 and should not be based on an assumption that all 835s are responding to 837s.
Submission 8/18/2011
Status Date 10/17/2011
Status F - Final
Primary References
Document 005010X221
Section2.4
Page127
Set ID835
Table2
Loop2100
Segment Position0100
Segment IDCLP
Element Position09