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Back  RFI # 2110: ICN/DCN for xx1 Type of Bill

Formal vs. Informal Help Informal Formal

Submitter

Jennifer Burger

Description

For 5010 837I:
A payer is requesting the ICN/DCN (payer claim control number) in Loop 2300, REF*F8 be sent for claims with Type of Bill xx1.

Per the TR3, this segment is:
SITUATIONAL
Required when CLM05-3 (Claim Frequency Code) indicates this claim is a replacement or void to a previously adjudicated claim. If not required by this implementation guide, do not send.

Type of Bill xx1 (CLM05-3 value of 1) is not a replacement (value of 7) or voided (value of 8) claim, so is this requirement compliant with ANSI standards?

Response

No, the requirement does not comply with the 005010X223A2 Technical Report Type 3. The receiver may not require the submitter to send the Payer Claim Control Number (2300 REF with F8 qualifier) if the claim is not a void or adjustment as indicated by the CLM05-3. The CLM05-3 value of 1 indicates the frequency is “Admit through Discharge Claim” which is not a void or replacement.
Submission 11/3/2015
Status Date 1/5/2016
Status F - Final
Primary References
Document 005010X223
Section2.4
Page166
Loop2300
Segment Position1800
Segment IDREF
Element Position02