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Back  RFI # 1538: 5010\837I\2300\CLM05-3 and REF

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Submitter

Tanya Kryltsova

Description

5010 837I TR3 for 2300/REF Payer Claim Control Number (REF01=F8) states: "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."
NUBC manual has following Claim Frequency Type (CLM05-3) codes associated with "replacement" or "void" claims: 7, 8, X and Y. Is it compliant with the TR3 to use noted above REF segment when CLM05-3 has code value indicating adjustment claim such as G or I?

Response

The 2300 payer claim control number allows senders to link the submitted claim to a specific claim within the payer system. It is consistent with the TR3 to use this data element as a means to communicate the specific claim to be adjusted. Although all of the Claim Frequency Codes you listed identify adjustment claims, we note that codes X, Y, G, and I are not applicable to the submission of claims by a provider to a health plan.
Submission 3/7/2012
Status Date 6/4/2012
Status F - Final
Primary References
Document 005010X223
Section2.4
Page166
Loop2300
Segment Position1800
Segment IDREF
Industry NamePAYER CLAIM CONTROL NUMBER