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Back  RFI # 1527: Submission of Late Charges

Formal vs. Informal Help Informal Formal

Submitter

Jane White

Description

We have a situation where a provider is not being allowed to send us the original claim number in the 837 I, 2300 REF Payer Claim Control Number, when submitting Late Charges using bill type 0xx5 because the situational rule says
Required when CLM05-3 (Claim Frequency Code) indicates this claim is a replacement or void to a previously adjudicated claim. If not required by this implementation guide, do not send.
The Payer Claim Control Number is only being allowed when the bill type is 0xx7 or 0xx8.
For us to be able to properly process late charges only claims, we need the original claim number to match up the claims. The same situation exists in the 837P.
I was not able to find anything on the NUBC site eliminating the use of Bill Type 0xx5.
Why was the use of this REF restricted to just voids and replacements?

Response

The payer claim control number is only used if the claim had been previously submitted and issued a claim ID number by the payer. The claim frequency code indicates if the current claim is an adjustment or a void to the designated claim. The original payer claim control number was omitted for late charges because no business need for this use was identified or requested



A claim frequency code of 5 is used for the initial filing of a claim with late charges.
Submission 2/21/2012
Status Date 4/9/2012
Status F - Final
Primary References
Document 005010X223
Section2300 REF