Section title: Requests for Interpretation
RFI #
2110
ICN/DCN for xx1 Type of Bill
Description

For 5010 837I:
A payer is requesting the ICN/DCN (payer claim control number) in Loop 2300, REF*F8 be sent for claims with Type of Bill xx1.

Per the TR3, this segment is:
SITUATIONAL
Required when CLM05-3 (Claim Frequency Code) indicates this claim is a replacement or void to a previously adjudicated claim. If not required by this implementation guide, do not send.

Type of Bill xx1 (CLM05-3 value of 1) is not a replacement (value of 7) or voided (value of 8) claim, so is this requirement compliant with ANSI standards?

RFI Response

No, the requirement does not comply with the 005010X223A2 Technical Report Type 3. The receiver may not require the submitter to send the Payer Claim Control Number (2300 REF with F8 qualifier) if the claim is not a void or adjustment as indicated by the CLM05-3. The CLM05-3 value of 1 indicates the frequency is “Admit through Discharge Claim” which is not a void or replacement.

DOCUMENT ID
005010X223