5010 TR3 note: The developers of this implementation guide note that the CN1 segment is for use only for post-adjudicated claims, which do not meet the definition of a health care claim under HIPAA. Consequently, at the time of this writing, the CN1 segment is for non-HIPAA use only.
Issue: AZ Medicaid has a contractual agreement with our health plans that requires the plans to submit Encounter data (post-adjudicated claims) using the 837 transaction, inclusive of the CN1 segment. For 5010, our Translation software vendor interprets this segment as ‘Not Used’ by HIPAA and therefore, should not be sent. Their interpretation to the note affects a large part of our EDI transactions. What is the final rule on the usage of the CN1 segment?
As specified by the Situational Rule and the TR3 Note, the CN1 segment in the Professional Claim is for use only for post-adjudicated claims, such as the plan to plan reporting function presented by the request. The segment is not used other than on post-adjudicated claims. A CN1 segment is valid under guide 005010X222 when submitted for post-adjudicated claims.