We are currently sending Other Related Claim Identification Class of Contract REF*CE segment as REF*CE*PARTICIPATING PROVIDER or REF*CE*NON PARTICIPATING, whether or not a CAS*CO is present. (Example: Claim pays in full - we still send this segment to identify if processed as PAR or NON-PAR.) Is this an acceptable usage of this segment in 5010?
The purpose of the OTHER CLAIM RELATED IDENTIFICATION segment is to provide additional information on adjudication of the claim in the associated CLP segment. Whether or not this adjudication results in an adjustment to the paid amount versus the billed amount based on a contractual obligation (CAS*CO), the provider's standing as PARTICIPATING or NON PARTICIPATING is relevant to the adjudication and therefore valid for use with REF*CE under the 5010 guide.