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Back  RFI # 2173: Loop 2300, REF01=F8 Control#

Formal vs. Informal Help Informal Formal

Submitter

Joyce Petrucci

Description

In reviewing RFI 1278 (version 5010), it is clear that this REF Payer Claim Control number can be sent with frequency codes 7 and 8. There is a new frequency code Q - claims submitted for reconsideration/reopening outside of timely limits (effective 1/1/2016)

Would frequency code Q, be consider valid for using the Loop 2300, REF01=F8?

Submitter Assigned Keywords

Payer Claim Control Number

Response

The 837I 005010X223A2, 2300 REF Payer Claim Control Number situational rule states 'Required when CLM05-3 (Claim Frequency Code) indicates this claim is a replacement or void to a previously adjudicated claim'. The rule does not specify which Claim Frequency Code values are considered to be “replacement” or “void” to a previously adjudicated claim.

Recommendation

Frequency Code Q is used for reopening/reconsidering a final determination or decision on a previously adjudicated claim that is outside of a payer's timely filing limits. When a provider submits a 'reopening/reconsideration' within the timely filing period, the provider would send a replacement claim (code value 7). A re-opening that is outside the timely filing limits might be considered a “replacement” claim and in those instances reporting the Loop 2300, REF01=F8 would be appropriate.
Submission 9/26/2016
Status Date 1/19/2017
Status F - Final
Primary References
Document X223.pdf
SectionLoop 230
Page166