Section title: Requests for Interpretation
RFI #
1786
2320 OI06 Note 837P
Description

he 2320 OI06 note states "This is a crosswalk from CLM09 when doing COB". Is the intent of this note to mean the 2300 CLM09 and 2320 OI06 should match, or does this mean in a COB situation the inbound 2300 CLM09 should be moved to that payers 2320 OI06 when sending to another payer.

For example: Medicare receives a Primary Claim where the 2300 CLM09 is I and there is a 2320-2330 for a Supplemental Trading Partner 12345. Within the 2320-2330 the OI06 is equal to Y. When sending the claim on to the Supplemental Payer 12345, is it correct that the 2300 OI06 for that payer be moved to the 2300 CLM09? Also, should the 2300 CLM09 received by Medicare be moved to the Medicare iteration of the 2300 OI06 being sent to the Supplemental payer 12345.

I engaged TG2/WG2 to assist in, and vet the following draft response:

RFI Response

The CLM09 is a claim level attribute obtained by the provider. This value does not change from payer to payer. Therefore, in version 5010, it would not make sense for the CLM09 and the OI06 not to be the same value. If these elements are different, one of the values is incorrect. The crosswalk depicted in Section 1.4.1.2 of the TR3 explains where to obtain data values when building a secondary claim, but in this case the values would be the same and a crosswalk is not needed. To address this confusion the OI06 element is no longer used in version 6020.

DOCUMENT ID
005010X222