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Back  RFI # 924: Release of information

Formal vs. Informal Help Informal Formal

Submitter

Kim Oberbroeckling

Description

I have a question about when to send the value 'I' in CLM-09 of the 2300 loop and/or OI-06 in the 2320 loop on professional claims. According to both the 4010 IG and the 5010 TR3:

I = Informed Consent to Release Medical Information for Conditions or Diagnoses Regulated by Federal Statutes

The 5010 TR3 also states that the value 'I' is required when the provider has not collected a signature AND state or federal laws do not require a signature be collected.

Reading the explanation in the TR3 leads me to the conclusion that what is sent in CLM-09 is not related to the diagnosis on the claim. It merely reflects what type of patient consent was received. I have a payer that is editing the CLM-09 and based on the claim's diagnosis code is rejecting the claim if CLM-09 is not 'I'. Is this an appropriate edit?

Submitter Assigned Keywords

CLM-09 OI-06 release

Response

In both 4010A1 and 5010 versions of the 837P, the value of CLM09 is not related to a specific diagnosis. CLM09 is used to report whether the submitter has the right to release the information on the claim and how the consent was obtained. The only valid values under the HIPAA Privacy rule are Y and I.
Submission 12/15/2009
Status Date 2/26/2010
Status F - Final
Primary References
Document 005010X222
SectionClaim
Page161
Set ID2300
Loop2300
Segment IDCLM
Element Position09
External Code ListI
Secondary References
RFI ID 834
Document 004010X098
Section2300
Page175
Set ID837
Loop2300
Segment IDCLM
Element Position09
Code ValueI