Section title: Requests for Interpretation
RFI #
1781
Patient Status CodeCL103
Description

This pertains to the 278 Request (005010X217).

The NUBC code values (Code Source 239: Patient Discharge Status) used for CL103 all presume that the patient has already been admitted.

However, an Admission Review transaction often is used for precertification of an upcoming admission, so the NUBC Patient Discharge Status codes available for CL103 would not apply.

This element appears to be required "when health care services review is for inpatient services," which whould always be the case when UM01=AR.

What are the appropriate code values to be sent in CL103 for an admission precertification?

RFI Response

CL103 is required when the health care services review is for inpatient service, which includes admission requests. Code source 239 is an external code list developed by the NUBC. To add code values to this list, a request would have to be made to the NUBC. Please note that the use of this segment in the 5010 version of the implementation guide was a concern and is marked as "Not Used" in the next version of the implementation guide.

DOCUMENT ID
005010X217 - X12N extended due date to 6/3/2013