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Back  RFI # 557: Final Claim Adjustment

Formal vs. Informal Help Informal Formal

Submitter

Patrice Kuppe

Description

If we send a 837I claim to payer as final. Then find out we missed some charges, how should the corrected 837I be indicated in the 837? Can payers refuse to take a corrected claim?

Submitter Assigned Keywords

837I Corrected Claim

Response

The National Uniform Billing Committee's (NUBC) UB-04 Data Specifications Manual, defines the valid codes for Type of Bill (TOB) codes, with Frequency Code as the last digit. TOB Frequency Code 5 = Late Charge(s) Only, and per definition, is used for submitting additional charges received by the provider after the Admit Through Discharge (1) or Last Interim Claim (4) claim has been submitted.
Reference: UB-04 Data Specifications Manual 2007, Version 1.00 September 2006, p. 16.

The 837I implementation guide along with UB-04 guidelines provide a standard way for claims to be submitted. Any question about whether a payer may refuse to accept a claim for late charges that is submitted according to the standard would be a question for CMS.
Submission 5/10/2007
Status Date 7/2/2007
Status F - Final
Primary References
Document 004010X091A1
SectionCLM
Page157
Set ID837I