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Back  RFI # 1808: 835 and 277CA Tracking

Formal vs. Informal Help Informal Formal

Submitter

Description

Hello,
There recently has been conversation around the need for the following values to match 100%...

835 - 005010X221A1
Loop 2100 - CLP07

&

277CA - 005010X214
Loop 2200D - REF*1K


While neither TR3 states that these values need to match it would seem that the intent of the values is to track a claim record from processing to adjudication. Please confirm if these values should, based on the needs of the X12 TR3's, match 100%.

Submitter Assigned Keywords

835 277CA CLP07 REF REF*1K REF1K CLP

Response

The Loop 2100 - CLP07 of the 835 (005010X221A1) and the Loop 2200D – REF02 (where REF01=1K) of the 277CA (005010X214) are expected to be the same value in most instances. The 277CA TR3 Note sets the expectation that the number assigned and reported ‘will be used to track the claim throughout the adjudication system.’ The Implementation Name identified for both of these elements is the ‘Payer Claim Control Number’, which further signifies their correlation as the same value and thereby the expectation that that they will match.

However, the Payer Claim Control Number reported in the 835 and 277CA may be different in the situation where a claim was split during processing, which is after the Payer Claim Control Number was assigned and originally reported in the 277CA. Even in this situation, it would only differ for a portion of the claim services. Additionally, there are reporting requirements defined in the 835 to assist with linking the ‘split portion’ of the claim back to the portion of the claim that still retains the original Payer Claim Control Number reported on the 277CA. See 835 Section 1.10.2.11 Claim Splitting for details. In addition, one or more reversals and corrections can result in these numbers being different if the health plan creates a new claim number for the corrected claim. See Section 1.10.2.8 for details.
Submission 6/4/2013
Status Date 7/12/2013
Status F - Final
Primary References
Document 005010X221
Section2.4
Page123
Loop2100
Segment IDCLP
Element Position07
Secondary References
RFI ID 2280
Document 005010X214
Section2.4
Page85
Loop2200D
Segment IDREF
Element Position02