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Back  RFI # 480: Balancing of CLP04 Element

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Submitter

Danielle Marquez

Description

The payer is stating that their file is HIPAA compliant, but in the examples below they are listing *11111~ in CAS03. If I utilize the balancing guidelines in the HIPAA IG the CLP04 element does not balance. Can you verify for me that these examples are not HIPAA compliant? If they are compliant please explain. Thank you.

CLP*4624880391*4*10726*0**LM*20629851002000962*16*3**430~ <-- HERE
CAS*CO*A1*11111~ <--HERE
NM1*QC*1*#######*########****MI*########~
NM1*IL*1*#######*#######*#***MI*#########~
NM1*82*1*########*#####****MC*########~
DTM*050*20061025~
DTM*232*20060501~
DTM*233*20060531~
LX*3~

CLP*########*4*6228*0**LM*20629851002000963*16*4**430~ <--HERE
CAS*CO*A1*11111~ <--HERE
NM1*QC*1*######*######****MI*#########~
NM1*IL*1*########*#######*#***MI*#########~
NM1*82*1*########*#####****MC*########~
DTM*050*20061025~
DTM*232*20060601~
DTM*233*20060618~
LX*4~

Response

Guide 004010X091 explicitly addresses this issue. Section 2.2.1.2 specifically outlines a balancing requirement for the 835. The examples provided are NOT compliant with that algorithm. Based on the first example, the formula would be 10726-11111=0, which is not accurate.
Submission 11/9/2006
Status Date 11/14/2006
Status F - Final
Primary References
Document 004010X091A1
Section835-2100
Page91
Set IDCLP04
Loop2100
Segment Position010
Segment IDCLP
Element Position04