Is it allowable to have different values in Loop-ID 2300 Claim Information, REF02 – Payer Claim Control Number than from Loop-ID 2330B Other Payer Name, REF02 – Other Payer's Claim Control Number, where REF01=F8 and SBR06=6 (no COB)?
Medicaid Payer receives encounter files via PACDR formats from multiple Managed Care Entities (MCEs). MCE submits an initial encounter with REF01=F8 and REF02 – Payer Claim Control Number is 20000 (for example) in the 2300 segment.
Subsequently, the MCE receives an adjustment (or void) from the provider (CLM05-3=7or8). To maintain the relationship to the original encounter, can the Medicaid Payer require the MCE to populate 2330B REF01=F8, REF02 – Other Payer's Claim Control Number with 20000 from the original encounter while 2300, REF=F8, REF02 – Payer Claim Control Number be a different number pertaining to the adjusted new encounter?
The functionality to send a prior adjudication claim number linkage is in Loop-ID 2330B REF – Other Payer Adjusted Claim Control Number for when Loop-ID 2320 SBR06 = ‘6.’ It is the developing workgroup’s intent that the value sent in the Loop-ID 2330B REF – Other Payer Adjusted Claim Control Number should have been sent in the prior submission as the Loop-ID 2330B REF – Other Payer Claim Control Number. This is how the linkage between versions of a claim is to be accomplished.
The value in Loop-ID 2300 REF – Payer Claim Control Number can be different from the value in Loop-ID 2330B Other Payer Claim Control Number. X12 cannot comment on whether a Medicaid Payer, or any party, can require the submitting payer to populate any of the REF segments mentioned in this RFI with a particular value. This is left up to be agreed upon by the parties.