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Back  RFI # 1760: 837 PACDR CN104 Contract Code

Formal vs. Informal Help Informal Formal

Submitter

CHERYL KELLY

Description

837P X222, X298 - Loop 2300, 2400 CN104
837I X223, X299 - Loop 2300 CN104
837D X224, X300 - Loop 2300, 2400 CN104
DE: 127
Implementation name: Contract Code
Organization type: Medicaid

We would like to request for information on how the CN104 Contract code data element is used. Is the data value for that element based on internal values (non-industry code set) that are agreed between Trading Partners?

Submitter Assigned Keywords

837 PACDR CN104 Contract Code

Response

The 837 Technical Reports Type 3 (TR3s) provide the following guidance on the use of Contract Code.



In the claim submission TR3s (005010X222A1, 005010X223A2, 005010X224A2), the CN1 Segment Situational Rule specifies that the CN1 segment is required when the submitter is contractually obligated to supply this information on post-adjudicated clams. The Segment Note further clarifies that the CN1 segment is used only for post-adjudicated claims and not for the HIPAA-adopted uses of the 837 transaction.



In the Post Adjudicated Claims Data Reporting (PACDR) TR3s (005010X298, 005010X299, and 005010X300), the CN1 Segment Situational Rule also specifies that the CN1 segment is required when the information is necessary to satisfy contract requirements.



Appendix E of these TR3s defines Contract Code as ‘Code identifying the specific contract, established by the payer.’



Therefore, you are correct that the codes used in CN104 are not industry standard codes, but rather proprietary codes established by the payer that created the insurance contract. Further, the contract information contained in the CN1 segment is only sent when the sender and receiver of the post-adjudicated claim have agreed to do so.
Submission 3/7/2013
Status Date 4/2/2013
Status F - Final
Primary References
Document 005010X222
Section2.3
Page187
Set ID837
Table2
Loop2300
Segment Position1600
Segment IDCN1
Element Position04
Industry NameReference Identifier