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Back  RFI # 1981: 835 reversal reporting NM1*TT

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Submitter

Jeanne Kirkpatrick

Description

If an 835 reports CLP02 with 19 and the NM1*TT indicating the claim was transferred to a crossover carrier, and then a reversal is done, is it compliant to report the NM1 segment on the 835 reversal even though the CLP02 is now 22?

It is being questioned because the TR3 Loop 2100 NM1 situational rule states “Required when…(CLP02 equals 19, 20, 21, or 23)” and the reversal reports CLP02 with 22. The person who is questioning whether is this compliant, believes you can only report NM1*TT when CLP02 is 19, 20, 21, or 23.

We believe reporting this NM1 segment on a reversal is compliant because the situation rule does not state it cannot be reported with other CLP02 qualifiers. Plus Section 1.10.2.8 states "....the method for revision is to reverse the entire claim....".

Submitter Assigned Keywords

835 reversal NM1*TT

Response

The situational Rule for the NM1 segment with the TT qualifier states “Required when the claim is transferred to another carrier or coverage (CLP02 equals 19, 20, 21 or 23). If not required by this implementation guide, do not send.” So when CLP02 is 22 it is not required, and must not be sent.
Submission 10/9/2014
Status Date 1/28/2015
Status F - Final
Primary References
Document 005010X221
Section1.10.2.