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Back  RFI # 2135: CLM05-03 usage

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Submitter

Andrew Lee

Description

We have a payer that is returning secondary payments as a Status 1 in the CLM05-03 in the 835 transactions.

We have contacted the payer and they have no plans to correct this issue. This issue has been going on for 8 months.

Is this allowable per the X221 Guide?

Response

Returning secondary payments with a value of 1 in the 835 claim status code (2100 CLP-02) is not compliant with the 005010X221A1 guide.

A value of 1 in the claim status code indicated that the claim was processed as primary. Secondary payments are to be reported with a value of 2.
Submission 3/16/2016
Status Date 4/18/2016
Status F - Final
Primary References
Document 005010X221