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Back  RFI # 874: 835-Hosp vs. Physician claim

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Submitter

Meledie Meyer

Description

In the 835, is there a definitive way to identify a hospital claim from a physician claim? We have trade partners who want to parce out one type from another, and we want to be sure that we correctly identify them in the 835.

Response

There is no single indicator within either the 4010 or 5010 that would allow you to uniquely identify institutional vs. professional claim payments. There may be information returned in CLP08 if returned by the payer or a claim number range.

Recommendation

Providers that submit physician and hospital claims can differentiate them on the 835 using CLP01 if they create CLM01 values on the claim side that allow for that differentiation.
Submission 10/2/2009
Status Date 1/7/2010
Status F - Final
Primary References
Document 004010X091A1
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