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Back  RFI # 581: NUBC manual value code usage

Formal vs. Informal Help Informal Formal

Submitter

matthew klischer

Description

The NUBC manual states that value codes A1, A2, A7, B1, B2, B7, C1, C2, and C7 are only to be used on paper claims. For electronic 837 claims, use Loop ID 2320 CAS segment (Claim Adjustment Group Code "PR").
This NUBC manual usage note has created confusion about where to populate this data on an inbound 837 as well as an 837 COB (as the result of an inbound UB-04 claim) if the VC data (that would have been present in value codes A1, A2, A7, B1, B2, B7, C1, C2, or C7) contains line level adjustment data which needs to be in the 2430 CAS per the IG. Suggest clarifying manual language be added. Suggested language:
This direction (For electronic 837 claims, use Loop ID 2320 CAS segment) does NOT imply that adjustments that might previously be reported on an 837 using the VCs A1, A2, A7, B1, B2, B7, C1, C2, or C7 must now all be reported in the 2320 CAS. IG requirements that apply to reporting of adjustments in either the 2320 or 2430 CASs apply when submitting 837s that involve such adjustments.

Response

The NUBC has defined the following value codes are no longer valid for submission in 837 transactions.

They are: A1, A2, A7, B1, B2, B7, C1, C2, and C7.

If 837 submitters historically included BOTH the value codes listed and the appropriate CAS segments to represent these adjustment amounts, the only change necessary is to omit the value codes from the transaction.

Recommendation

On the other hand, if the 837 was created using only the value code amounts to represent these adjustment amounts, appropriate CAS segments using Claim Adjustment Group Codes and Claim Adjustment Reason Codes must be used. These adjustments are to be reported at either the line (Loop ID 2430) or the claim (Loop ID 2320) level as received on the prior payer's remittance advice. If mapping from the value codes, the only option is to report them at the claim level (Loop ID 2320).
Submission 7/24/2007
Status Date 10/22/2007
Status F - Final
Primary References
Document 004010X096A1
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