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Back  RFI # 2224: REF*6R FORMAT in 835's

Formal vs. Informal Help Informal Formal

Submitter

LOU ANN STOAKLEY

Description

We are looking at an internal system enhancement and there are variations in how data is displayed in the REF*6R (2110) line.
We see dashes OR (.) separating the NPCPD and then the RX #, some with leading -0-, etc. I have ID'd at least 5 different variations. This is occurring in State Medicaid's and DME files.

Is there any directive on how this should be entered?

Also, can I clarify with you that we would only have the REF*6R in an 835 if it was passed from the 837?

Submitter Assigned Keywords

REF*6R

Response

Draft – These issues are explicitly addressed in the 005010X221A1 TR3. The Line Item Control Number REF02, data element 127 has the attribute of AN. Section B.1.1.3.1.4 String reads as follows:

“A string data element is a sequence of any characters from the basic or extended character sets. The string data element must contain at least one non-space character. The significant characters shall be left justified. Leading spaces, when they occur, are presumed to be significant characters. Trailing spaces must be suppressed unless they are necessary to satisfy a minimum length. The representation for this data element type is "AN."”

Section B.1.1.2.2 defines the Basic Character Set. Zeroes, dashes, and periods are within the Basic Character Set and may be part of the string in any order. Zeroes at the beginning of the string are not considered leading zeroes.

The Situational Rule of the 2110 REF – Line Item Control Number states: “Required when a Line Item Control Number was received on the original claim or when claim or service line splitting has occurred. If not required by this implementation guide, do not send.”

Section 1.10.2.11 Claim Splitting reads in part:

“If the original claim did not contain a specific line item control number for the service lines, the line item sequence number (LX01) from the original claim must be used in the 835 REF segment instead.”

Section 1.10.2.14.1 Service Line Splitting reads in part:

“Return the line item control number from the original line on all split lines. If no line item control number was received, use the original line item sequence as the line item control number.”

Therefore, the 2110 REF – Line Item Control Number would only be returned in the 835 if the Line Item Control Number was received in original claim, unless claim or line splitting has occurred. If claim or line splitting occurred, it would then also be required as indicated above.

Recommendation

Standard X12.6 defines the basic and extended character sets (section 3.3) and the string data element type (section 3.5.1.4).

RFI #1684 also addresses the issue of when the 2110 REF – Line Item Control Number must be sent, and must not be sent in an 835.
Submission 8/3/2017
Status Date 10/12/2017
Status F - Final
Primary References
Document 005010X221
Section2.4
Page206
Loop2110
Segment PositionREF01