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Back  RFI # 2189: Invalid Payer Sequence Order

Formal vs. Informal Help Informal Formal

Submitter

Tia Martinez

Description

When submitting a claim to a Primary Payer (Loop 2000B SBR01 = 'P'), is it appropriate to include Other Subscriber (2320) loops indicating Secondary and/or Tertiary Payers? (Loop 2320 SBR01 = 'S' and/or 'T')?

We have a provider submitting this way after they have sent the claim to another Medicaid agency not responsible for the claim, and found the claim truly needs to come to us (The Primary Payer).

Response

It is appropriate to include other subscriber information on a primary claim.

The situational rule for the 2320B reads ”Required when other payers are known to potentially be involved in paying on this claim. If not required by this implementation guide do not send” This information must be submitted when known even if the payer has not processed the claim. This information can be used to route claims in a payer to payer coordination of benefit model. More information on coordination of benefits can be found in section 1.4.1 of the guide.
Submission 1/13/2017
Status Date 2/21/2017
Status F - Final
Primary References
Document 005010X222A1
Section2.4
Loop2320
Segment IDSBR
Element Position01