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Back  RFI # 525: CLM01&CLP01 Not Equal

Formal vs. Informal Help Informal Formal

Submitter

Ginger Wright

Description

Please clarify the use of the Patient Control No (DE# 1028). The CLM01 gray note says “Characters beyond 20 are not required to be stored nor returned by any 837-receiving system.” Does this “HIPAA maximum length requirement” mean an 837-receiver should reject claims that have a value in CLM01 that is greater than 20? Is a clearinghouse an "837-receiver" or "responding system" if they’re not storing the CLM01 and not creating the associated 835? If the responding system only supports and stores 20 characters and the provider submitted a 30 character value, how can the responding system comply with the 837 CLM01 and 835 CLP01 rules? If the responding system has truncated 10 characters, the value that would “echo back” in the CLP01 is no longer identical to the value received on the original claim (CLM01). Was the expectation that all provider’s and PMS vendors would restrict their unique patient control numbers to 20 characters?

Submitter Assigned Keywords

CLM01 CLP01

Response

As explained in the response to HIR#419, the receiver is required to support a minimum of 20 characters in the patient control number. It is not appropriate to reject a claim that has more than 20 characters; rather, the receiver must capture and proceed with adjudication with a minimum of the first 20 characters.

A clearinghouse must also be capable of capturing a minimum of 20 characters in this element. Any question about a clearinghouse's capabilities to capture more than 20 characters is a business issue between the clearinghouse and the provider or payer that is arranging for the clearinghouse's services. That is, the transaction standards do not require a clearinghouse to accept and forward on more than 20 characters.
Submission 3/2/2007
Status Date 5/7/2007
Status F - Final
Primary References
Document 004010X096A1
Section3
Page161
Set ID837
Table2
Loop2300
Segment Position130
Segment IDCLM
Element Position01
Industry NamePatient Control Number
Secondary References
RFI ID 476
Document 004010X091A1
Section3
Page89
Set ID835
Table2
Loop2100
Segment Position010
Segment IDCLP
Element Position01