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Back  RFI # 695: CLP06 correct assigment of

Formal vs. Informal Help Informal Formal

Submitter

Kellene Parthemore

Description

I have 2 questions concerning the correct Claim Filing Indicator Code to use for specific Medicare and Medicaid replacement plans.

1. For the Medicare Private Fee for Service products that replace Medicare part A and B, What is the best and industry standard code to use, MB?

2. For Medicaid plus HMO plans, should the CLP06 still use the MC code to denote it is Medicaid or HM to state it is an HMO.

Submitter Assigned Keywords

CLP06 MC MB MA HM

Response

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 intent within the 835 for the Claim Filing Indicator Code is to identify the type of contractual relationship that exists related to the claim between the payer and the provider. For Medicare Part A & B that is a legislated relationship and the values are indicated. For Medicare Private Fee for Service products, Medicare is no longer the direct payer. The type of contractual relationship between the payer and the provider must be identified. For example, if that relationship is a PPO, use code 12. For a Medicaid Plus HMO, use HM to identify that payment is made under an HMO contract.
Submission 10/7/2008
Status Date 12/5/2008
Status F - Final
Primary References
Document 004010X091A1
SectionCLP06
Page92
Set ID1032
Loop2100
Segment IDCLP
Element Position06
External Code ListClaim Filing Indicator Code