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Back  RFI # 147: 276 claim status REF 1K

Formal vs. Informal Help Informal Formal

Submitter

Deborah Belcher

Description

Please clarify the use of REF with 1K qualifier. I interpret that it can be used as either the Provider's Account Number or the Payer's Claim Number, as an identifier for matching a claim status request.

Trading partner is stating that it can only be the payer's claim number. For the provider sending an initial 276 request, the payer's claim number is not known. The provider wants to send the provider account number in REF 1K. I think that the IG allows this. Thanks

Response

The 276 REF Segment with qualifier 1K is only used to send the Payer’s Claim Control Number. All usage notes for the 276, except the ‘Alias’ name in Loop 2200D, identify use of this segment for the ‘Payer’s Claim Control Number’. The addenda 004010X93A1, page 7 corrected errata in Section 2.2.3.3.2, by changing the example references from ‘Patient Account Number’ to ‘Payer’s Claim Control Number’. The TRN Segment may be used to report the Patient Account Number.
Submission 11/19/2004
Status Date 1/6/2005
Status F - Final
Primary References
Document 004010X093
Section2.2.3.3.
Page30
Set ID276
Table2
Loop2200D
Segment Position100
Segment IDREF
Element Position01
Industry NamePatient Account Number
Code Value1K
Secondary References
RFI ID 111
Document 004010X093
Section2.2.3.3.
Page103
Set ID276
Table2
Loop2200E
Segment Position100
Segment IDREF
Element Position01
Component Position02
Industry NamePatient Account Number
Code Value1K