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Back  RFI # 173: Is CRC Segment Req'd if EPSDT?

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Submitter

Kenneth Greenspan

Description

In the 837P addendum on page 36, there is a requirement for the CRC segment that reads, "1. Required on EPSDT claims/encounters." However, I purchased the combined 837P guide (standard guide plus addendum), and on page 239, there is no mention of this requirement, that the CRC segment is required if the claim is an EPSDT (CLM12 = "01".)

Currently, our translator traps this rejection, but claredi does not. Could you please clarify which is correct? Is this a real requirement, or is this just an error in the combined guide.

Submitter Assigned Keywords

CRC EPSDT

Response

This issue is addressed in the 004010X098A1 Addenda document on page 37. The CRC Segment for EPDST Referral is a new iteration of the CRC segment added to the 837P implementation by the Addenda. This new segment is in the WPC Combined guide on page 249.

Recommendation

Submission 1/7/2005
Status Date 1/24/2005
Status F - Final
Primary References
Document 004010X098A1
SectionAddendum
Page36
Set IDCRC