RFI Browser

Back  RFI # 2029: Proper CLP02 Use

Formal vs. Informal Help Informal Formal

Submitter

Andrew Lee

Description

There are certain payers, namely Blue Cross, who will send back a CLP02 as a Primary, regardless of the fact we sent the claim as a Secondary with a SBR01=P. I would like an interpretation of the spec saying that there needs to be link between the two that if we send a Secondary claim, the Payer must send a Secondary Payment.

Response

The CLP02 is defined as “Code identifying the status of an entire claim as assigned by the payer, claim review organization or repricing organization”. Therefore, the entity that adjudicated the claim must accurately report how the claim was adjudicated in the CLP02. There is no cross TR3 requirement between the version 5010 837 Professional Claim, and the 835 Remittance that the CLP02 returned in the 835 must be the same as that submitted in the SBR01 of the 837 Professional Claim.
Submission 3/17/2015
Status Date 4/22/2015
Status F - Final
Primary References
Document 005010X222
Section1.1
Page116
Loop2000B
Segment IDSBR
Element Position01
Secondary References
RFI ID 2508
Document 005010X221
Section1.1
Page124
Loop2100
Segment IDCLP
Element Position02