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Back  RFI # 169: Country Code (CLM11-5)

Formal vs. Informal Help Informal Formal


chip dycio


A payer is rejecting our entire 837p file, via the 997 Functional Acknowledgment, if any claim contains the auto accident country code (CLM11-5) along with the auto accident state code (CLM11-4). They tell us that we cannot send the country code if we send a state code. According to the IG, I see nothing that prohibits the use of both the state code and country code on a claim. The country code we are sending is a valid code (US).

Submitter Assigned Keywords

837p country code state code


This issue is explicitly addressed in guide X098 in section 3 on pages 49 and 178. CLM11-5 is situational and required when not "US". Page 49 defines situational and includes "The item should be used whenever the situation defined in the note is true; otherwise, the item should not be used." While "US" should not be sent, sending it is not prohibited according to this guide.
Submission 12/14/2004
Status Date 3/16/2005
Status F - Final
Primary References
Document 004010X098A1
Set ID837
Segment Position130
Segment IDCLM
Element Position11
Component Position5
Industry NameCountry Code