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Back  RFI # 606: Claim Filing Indicator Code

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Submitter

Jennifer McMullin

Description

There is a requirement in the 2100 CLP06 element that states the following: "The value should mirror the value received in the original claim (2-005 SBR09 of the 837), if applicable, or provide the value as assigned or edited by the payer."

There are 7 SBR09 values in the 837 that are not available as a valid value for CLP06: 09, 10, 11, BL, CI, LI, and ZZ.

If we are to populate the CLP06 element from the inbound 837 SBR09 values, what do we populate if one of the above-mentioned codes are supplied? Won't they reject in the 835 as invalid values?

Submitter Assigned Keywords

CLP06 Claim Filing Indicator

Response

This issue is explicitly addressed in guide 004010X091. As you stated, the guide says "The value should mirror the value received in the original claim (2-005 SBR09 of the 837), if applicable, or provide the value as assigned or edited by the payer." The values are not the same as the values contained in the 837. The difference is by design since the purpose is different. When a code is used in the 837 that is not supported in the 835, that value is not applicable to the 835, and cannot be used there. Another valid value from the list in guide 004010X091 must be used in its place.
Submission 9/27/2007
Status Date 10/5/2007
Status F - Final
Primary References
Document 004010X091A1
SectionLoop2100
Page92
Set ID835