RFI #
1766
835-filing ind. patient term
Description
On the 835, what is the appropriate claim filing indicator on a claim denial due to lack of coverage for the patient. Since there isn't coverage there isn't a product to use like PPO or POS.
RFI Response
The 005010X221 explicitly requires the value received in the 837 SBR09 be returned in the 835 2100 CLP06 unless a more specific value can be determined during adjudication. In the event that the claim is a paper claim, the most appropriate value for the health plan the claim was submitted to would suffice, such as code C1 – Commercial if you are unable to determine if the product the claim was filed for was a PPO or POS type of health plan.
DOCUMENT ID
005010X221