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Back  RFI # 806: 2330B Other Payer Secondary ID

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Submitter

Marcia Henderson

Description

We are a payer which requires the Medicare Claim Control Number (CCN) be submitted on a provider submitted secondary claim when Medicare is primary. Most claims are handled through the payer to payer COB process, but in some instances the provider must submit the claim directly to us.

We are asking providers submit the Medicare CCN in the 2300 NTE with a qualifer of ADD.

We considered using the 2330B REF (Other Payer Secondary
Identifier) with a qualifier of F8 for Original Reference Number. Note #2 of the 2330B segment specifically notes the F8 qualifier is used for payer-to-payer COB and is not used by providers. (We are please to see this changed with version 5010.)

Is the use of the 2300 NTE non-compliant? Is the use of the 2330B REF non-compliant since it specifically notes it is not used by providers?

What is the appropriate field to have providers submit the the Medicare CCN in version 4010A1?

Response

In the 4010A1 version of the 837 Professional Claim, segment note 2 on the 2330B Other Payer Secondary Identifier REF segment specifically excludes the sending of a previous payer's claim control number (qualifier F8) for provider to payer COB. It is also not supported in any other segment in the Professional Implementation Guide. This data is only permitted on payer to payer COB. That is, sending this data in the 2300 NTE or the 2330B REF for a provider submitted claim is not compliant with the 4010A1 837 Implementation Guide.

Recommendation

For provider to payer COB in the 5010 version, the previous payer's claim control number must be sent when that claim number is available to the provider. A receiver may not require the provider to always submit it.
Submission 6/18/2009
Status Date 8/3/2009
Status F - Final
Primary References
Document 004010X098A1
Section3.0
Page368
Set ID2330B