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Back  RFI # 418: 835 crossovers

Formal vs. Informal Help Informal Formal

Submitter

Dyan Anderson

Description

Besides appropriate use of the CLP02 claim status code, are there any other requirements for payer in crossover situation?
Based on 835 files we've received from Blue Cross and a Medicaid plan, the NM1*TT is not being used by the primary payer. Is this allowed or should we reject the file?

Submitter Assigned Keywords

835 crossover CLP01 NM1*TT

Response

It is the intent of the authors that the Crossover carrier name is required when a claim has been forwarded to another payer for consideration by the current (the one creating the 835) payer. If the data is missing when this situation has occurred, that 835 would not be in compliance with the intent of the implementation guide.

Recommendation

DISCLAIMER: X12N's interpretations are intended only to clarify the implementation guides.
It is not within X12N's scope to comment on the actions of specific entities
such as regulatory bodies, carriers, and providers, nor to render an opinion on
an individual entity's compliance with HIPAA or other federal or state
regulations. Requests concerning interpretations of the HIPAA regulations as
issued by the Department of Health and Human Services should be submitted via
email to askhipaa@cms.hhs.gov.
Submission 6/16/2006
Status Date 8/25/2006
Status F - Final
Primary References
Document 004010X091A1
Sectionclaim
Page89
Set ID835
Loop2100
Segment PositionCLP01
Segment IDCLP
Element Position01
Industry NameClaim Submitter's Identifier