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Back  RFI # 621: Claim Estimate Indicator

Formal vs. Informal Help Informal Formal

Submitter

Jennifer McMullin

Description

Is there an indicator in the 837I or 837P guides that indicates that the transaction is a estimate request and not an actual claim? The 837D has a predetermination indicator in the 2300 Loop CLM19 element, however there doesn't seem to be a similar indicator for medical claims.

Response

Indicating if a transaction is an estimate or predetermination request is not explicitly supported within the Institutional or Professional 837 Guides.

Recommendation

There is a joint WEDI/X12 Real Time Claim Adjudication project that will be reviewing requirements for estimation/predetermination requests.
Submission 1/8/2008
Status Date 4/3/2008
Status F - Final
Primary References
Document 004010X097A1
SectionLoop2300
Page148
Set ID837D