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Back  RFI # 2150: CLP01 in a Reversal

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Submitter

Andrew Lee

Description

For a corrected claim where the payer does a reversal and repayment, i'd like to know what value the CLP01 should have

We send a claim with a CLM01 = 12345
It pays with a CLP01 = 12345

We send a corrected claim with CLM01 = 67890
It pays with a CLP01 = 67890

However what i want to know, is if the CLP01 of the reversal should be equal to 12345 or 67890? Should it have the value of the initial claim, or the corrected claim?

Submitter Assigned Keywords

CLP01

Response

The patient control number is supplied in the 2300 CLM01 and returned in the 2100 CLP01. This element is used to enable the posting of information in the patient account system including payments and reversals. A provider is not required to change the patient control number when filing a corrected claim.

If a provider chooses to change the patient control number then the reversal should reflect the original CLM01 in CLP01 (12345 in this example). The payment for the corrected claim would then reflect the new CLM01 (67890 in this example) in CLP01. Since the corrected claim replaces the original claim, if the payer initiates additional action on the claim the new patient control number should be referenced.

If the provider submits the same patient control number 2300 CLM01 on the original and corrected claim, then both the reversal and correction payment would reflect that original CLM01 (12345 in this example).

Recommendation

While there is no requirement to keep the same patient control number, leaving it unchanged may simplify the posting process with the patient accounting system.
Submission 5/26/2016
Status Date 8/24/2016
Status F - Final
Primary References
Document 005010X223
Section1.10.2.8
Page29
Loop2100
Segment IDCLP
Element Position01