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Back  RFI # 974: Use of "Unknown"

Formal vs. Informal Help Informal Formal

Submitter

Rob Corea

Description

We are a Property and Casualty bill review vendor. We represent a significant cross section of this Industry. Our processes rely on the integrity of the data within the 837 claim. We are aware of HIR 664 that indicates that the Property and Casualty claim number is required if the claim is being billed to a Property and Casualty payer. However, we are also aware of IAIABC companion guides that indicate that a default value of "UNKNOWN" may be submitted for a Worker's Compensation claim. In light of the Situational Note in 4010A1 and 5010, that indicates the "payer assigned claim number" is required, are default values allowed? A default value not "assigned by the payer" and not used at the authorization of the payer seems to be contradictory to the usage rule. If a default value not authorized by the payer is allowed, how do you justify such usage?

Submitter Assigned Keywords

Property & Casualty

Response

The requirement for the Property and Casualty Claim Number, which includes Worker’s Compensation claims, is addressed in the 4010A1 and 5010 versions of the 837 Implementation Guides. This is defined as a "payer-assigned" number and is required for Property and Casualty claims. Therefore, use of a default value of “UNKNOWN” in this data element is contradictory to the Implementation Guide unless the use of the default value is at the direction of the payer.

Recommendation

An appropriate default value would be acceptable if the claim number was not yet assigned by the payer, and the payer directs the use of the default value.
Submission 2/23/2010
Status Date 4/9/2010
Status F - Final
Primary References
Document 004010X098A1
Section4.2
Page586
Set ID2010BA