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Back  RFI # 1766: 835-filing ind. patient term

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Submitter

Frank Russo

Description

On the 835, what is the appropriate claim filing indicator on a claim denial due to lack of coverage for the patient. Since there isn't coverage there isn't a product to use like PPO or POS.

Submitter Assigned Keywords

835 claim filing indicator patient without coverage

Response

The 005010X221 explicitly requires the value received in the 837 SBR09 be returned in the 835 2100 CLP06 unless a more specific value can be determined during adjudication. If you are unable to determine the product the claim was filed for, code ZZ - Mutually Defined is appropriate.
Submission 3/16/2013
Status Date 8/21/2013
Status F - Final
Primary References
Document 005010X221
Section2.4
Page126
Loop2100
Segment IDCLP
Component Position06