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Back  RFI # 457: CLP02 - Is 5 allowed?

Formal vs. Informal Help Informal Formal

Submitter

Janice Cunningham

Description

A payer is reported Claim Status 5 in CLP02. Per the IG, this code is "Not Advised". I explained that the intent of the X12 Workgroup is "No Advised" actually means not allowed.
Payer states they go by what is stated in the IG. Since it is not stated that Not Advised indicates Not Allowed the payer does not agree that Claim Status 5 is not allowed.

Could you verify if the payer can use this code?

Response

This issue is explicitly addressed in guide 004010X091. CLP02 does allow usage of code "5" (Pended). The notation of "Not Advised" is a caution that this value should be avoided, and may not be available in
future guides. However, the fact that the guide includes the value makes it usable. It does not make code "5" "Not Used".

Recommendation

The value is removed from the next (4050 and 5010) 835 guide and the authors recommend that it not be used.
Submission 9/27/2006
Status Date 1/3/2007
Status F - Final
Primary References
Document 004010X091A1
Section835 2100
Page90
Set IDCLP02
Loop2100
Segment IDCLP
Element Position02