RFI Browser

Back  RFI # 851: Medicare Assignment Indicator

Formal vs. Informal Help Informal Formal

Submitter

Barbara Sesny

Description

The reporting requirement for CLM07 has been changed from being the Medicare Assignment Indicator to being the Assignment/Participation Indicator for the destination payer. It appears that the Medicare Assignment Indicator will no longer be available on payer-to-payer crossover claims. Can you please confirm my assumption that there is not an alternate data element in which to receive this information?

Response

CLM07 (Assignment or Plan Participation Code) applies to the destination payer only. It was not the intent of the 4010 guide for CLM07 to be used on a crossover claim from Medicare to indicate the Medicare Assignment Code, although that is not specifically stated in the 4010 guide. It is specifically addressed in the 5010 guide that CLM07 applies only to the destination payer. Therefore, regarding payer-to-payer crossover claims, the requester is correct that there is no data element for the Assignment or Participation Code of the previous payer. And, there is no way for the payer creating a crossover claim to obtain and pass the provider's Participation Code for the subsequent payer that will receive the crossover claim. In 5010, the value in CLM07 on a crossover claim should always be "C, Not Assigned" because the payer building the claim will not know whether "A, Assigned" or "B, Assignment Accepted on Clinical Lab Services Only" apply.
Submission 9/9/2009
Status Date 11/20/2009
Status F - Final
Primary References
Document 005010X223
Section2.4
Page146
Set ID837