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Back  RFI # 1668: 2330B REF*F8

Formal vs. Informal Help Informal Formal

Submitter

Gloria Davis

Description

RFI 1048 addressed this issue in 4010 but have the same question in regard to 5010. Can a payer require a provider to send (when it is a provider to payer COB claim and not a payer to payer claim) to send the Other Payer Claim Control Number? The Situational Rule changed in 5010 from 4010 to read:

Required when it is necessary to identify the Other Payer’s Claim Control Number in a payer-to-payer COB situation.
OR
Required when the Other Payer’s Claim Control Number is available.
If not required by this implementation guide, do not send.

The payer in question is focusing on the Or statement: Required when the Other Payer’s Claim Control Number is available. If not required by this implementation guide, do not send. and stating that they can require the Medicare ICN Number.

Submitter Assigned Keywords

2330B REF F8 Other Payer Claim Control Number

Response

Since a payer can't determine the specifics of the requirements, a payer can't require the Other Payer's Claim Control number on provider submitted claims.

The intent of the second situational statement is that if the provider has received and is systematically able to send the other payer claim control number on the COB claim then they must do so.
Submission 8/22/2012
Status Date 11/13/2012
Status F - Final
Primary References
Document 005010X223
Page331
Set ID837
Loop2330B
Segment PositionREF
Industry NameOther Payer’s Claim Control Number