RFI Browser

Back  RFI # 1518: MACSIS Hlth 5010 835 Takebacks

Formal vs. Informal Help Informal Formal

Submitter

Chris Weber

Description

MACSIS who is a Behavioral Health Ohio has advised that with 5010 if multiple detail lines with the same postdate exists for a single claim, they will report the take back and payment under one CLP segment.
They will report the Claim Status as 22 (which no longer identifies the payer as primary or secondary).
Is this compliant with 5010 to combine the payment under one CLP with claim status of 22?

This article was published 01/04/12 titled: MACSIS Communication 5010 835 Upgrade

Thanks,
Chris

Submitter Assigned Keywords

MACSIS 835 Corrections Takebacks Reversals 5010 Single CLP for each SVC segment

Response

No, the use of one CLP with CPL02=22 as explained in this question is not accurate.

There was no change to the reporting of Reversal and Correction claims between 4010 and 5010. BOTH versions require ALL service lines submitted on the claim be reversed in the Reversal claim using CLP02=22 and then ALL service lines are sent again 'as corrected' in the Corrected claim using the applicable CLP02 value (ex. 1, 2, 3, etc.) There is no other way except as described in Section 1.10.2.8 (005010X221) to perform the reversal and correction process.
Submission 2/6/2012
Status Date 3/6/2012
Status F - Final
Primary References
Document 005010X221
Section1.10.2.8