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Back  RFI # 664: P&C claim number required

Formal vs. Informal Help Informal Formal

Submitter

Chip Evelsizer

Description

The 4010A1 Professional Guide in the 2010BA and 2010CA Property and Casualty Claim Number REF indicate in note number 2 that the P&C Claim Number is required on Property and Casualty claims in the REF02. However, Section 4.2 of the guide which discusses P&C usages indicates that if no claim number is available, then the subscriber’s policy number and date of loss should be sent. It appears this language was removed from Section 3.2 of version 5010. Which section of the 4010A1 Guide prevails? Can it be assumed this also applies to the 4010A1 Institutional and Dental Guides?

Response

This issue is explicitly addressed in guide 004010X098. The semantic note in the 2010BA and 2010CA Property and Casualty Claim Number REF segments makes the Property and Casualty Claim Number required when any of the 4010A1 837 Implementation Guides are being used to bill a Property and Casualty Payer. The inconsistent usage information in Section 4.2 was removed in version 5010.
Submission 6/4/2008
Status Date 8/7/2008
Status F - Final
Primary References
Document 004010X098A1
Section4.2
Page122
Set ID837