A previous RFI addressed this issue in 4010 but have the same question in regard to 5010. Can a payer require a provider to send (when it is a provider to payer COB claim and not a payer to payer claim) to send the Other Payer Claim Control Number? The Situational Rule changed in 5010 from 4010 to read: Required when it is necessary to identify the Other Payer’s Claim Control Number in a payer-to-payer COB situation. OR Required when the Other Payer’s Claim Control Number is available. If not required by this implementation guide, do not send. The payer in question is focusing on the Or statement: Required when the Other Payer’s Claim Control Number is available. If not required by this implementation guide, do not send. and stating that they can require the Medicare ICN Number.
Since a payer can't determine the specifics of the requirements, a payer can't require the Other Payer's Claim Control number on provider submitted claims. The intent of the second situational statement is that if the provider has received and is systematically able to send the other payer claim control number on the COB claim then they must do so.