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Back  RFI # 2091: Patient Control Number

Formal vs. Informal Help Informal Formal

Submitter

Claudette Sikora

Description

The TR3 notes for patient CNTRL No. on the 837 and 276/277 are inconsistent, possibly leading to different approaches to editing. Must payers use the same editing approach for both transactions, even if the TR3 notes do not match? The notes for this field for both TR3s indicate that the max. number of chars. to be supported is 20. However, the 837 note also has a statement indicating that characters beyond the maximum are not required to be stored nor returned. It appears that editing this No. can consist of truncating patient CNTRL No’s. greater than 20 chars. long, storing the 20, and accepting the transaction; or rejecting the transaction having greater than 20 characters for this number. Are both approaches acceptable for both transactions? Or is only one acceptable, i.e., truncating for the 837 and rejecting for the 276/277, per the TR3 wording (Refs: 837 Loop 2300 CLM01; 276 Loop 2200D (REF01=EJ); also, the max. field size is 38 for the 837 and 50 for the 276/277).

Submitter Assigned Keywords

Patient Control Number; 837; 276/277

Response

No, payers are not required to apply the same edit logic against the patient control number field in the 837 and the 276/277. Payers may apply different rules based on business needs.
It should be noted that the 837 TR3 does not prohibit a payer from storing more than the first 20 bytes of the patient account number. The payer could accept, store, and report a 38 byte value instead of truncating at 20 bytes. The payer is not required to store more than 20 bytes of the claim number from the 837 claim transaction.

The intent of the patient control number field within the 276/277 is to link to a 837 claim document. Since the maximum size of the patient control number is 38 bytes within the claim, the 276/277 value should never be more than 38 bytes long. However, since the element maximum length in the 276/277 is 50 characters, lengths greater than 38 and less than 51 do not represent a syntactical error.

When processing the 276 transaction the payer is only required to support a look up based on the first 20 bytes of the claim control number. The payer is not prohibited from performing a look up on more than 20 bytes if submitted.

Recommendation

If a payer receives data longer than 20 bytes but less than or equal to 38 then the payer should either perform the look up using the entire value or truncate the value to match the number of bytes that the payer stored when accepting the 837.
Submission 8/31/2015
Status Date 2/9/2016
Status F - Final
Primary References
Document 005010X223
Section2.4
Page144
Set ID837
Table2
Loop2300
Segment Position1300
Segment IDCLM
Element Position01
Industry NamePatient Control Number
External Code ListN/A
Code ValueN/A