Section title: Requests for Interpretation
RFI #
1808
835 and 277CA Tracking
Description

There recently has been conversation around the need for the following values to match 100%...

835 - 005010X221A1

Loop 2100 - CLP07

&

277CA - 005010X214

Loop 2200D - REF*1K

While neither TR3 states that these values need to match it would seem that the intent of the values is to track a claim record from processing to adjudication. Please confirm if these values should, based on the needs of the X12 TR3's, match 100%.

RFI Response

The Loop 2100 - CLP07 of the 835 (005010X221A1) and the Loop 2200D – REF02 (where REF01=1K) of the 277CA (005010X214) are expected to be the same value. The 277CA TR3 Note sets the expectation that the number assigned and reported ‘will be used to track the claim throughout the adjudication system.’ The Implementation Name identified for both of these elements is the ‘Payer Claim Control Number’, which further signifies their correlation as the same value and thereby the expectation that that they will match.

RFI Recommendation

The Payer Claim Control Number reported in the 835 and 277CA may be different in the situation where a claim was split during processing, which is after the Payer Claim Control Number was assigned and originally reported in the 277CA. However, even in this situation it would only differ for a portion of the claim services. Additionally, there are reporting requirements defined in the 835 to assist with linking the ‘split portion’ of the claim back to the portion of the claim that still retains the original Payer Claim Control Number reported on the 277CA. See 835 Section 1.10.2.11 Claim Splitting for details.

DOCUMENT ID
005010X214/X221