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Back  RFI # 1843: Function of REF02, EV Header

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Submitter

Patrice Durham

Description

As an exclusive clearinghouse for a payer’s 835 files, we would like to know if the REF 02 in the header with an EV qualifier can house the ending Clearinghouse receiver id. We are unclear of the function of this segment. The TR3 Notes are;

This is the business identification information for the transaction receiver. This may be different than the EDI address or identifier of the receiver. This is the initial receiver of the transaction. This information must not be updated if the transaction is routed through multiple intermediaries, such as clearinghouses, before reaching the payee.

As the initial clearinghouse we would not be changing the information provided by the payer, simply passing the information the payer sent identifying the final Clearinghouse destination. We would be able to direct the remit to the appropriate Clearinghouse based on the receiver id in the REF 02. Please provide clarification on this field.

Response

The key phrase in the third sentence of the first paragraph "This is the initial receiver of the transaction" spells out what is to be present in this field. This is to allow the provider to determine where the 835 was originally delivered by the payer.

If it is the health plan and they send it to the clearinghouse then the clearinghouse gets identified in the REF. If the health plan sends proprietary formatted information to the clearinghouse, and the clearinghouse creates the 835, then that clearinghouse isn't identified, but the entity that gets the 835 from the clearinghouse (if different than the payee) is identified in the REF.
Submission 8/12/2013
Status Date 9/26/2013
Status F - Final
Primary References
Document 005010X221
Section2.4
Page57
Set ID835
Table1
LoopHeader
Segment Position01
Segment IDREF
Element Position02
Industry NameReceiver Identifcation number
Code ValueEV