When adding charges to a prior claim with the same or different CLP01 value, if the lines you are adding came in on an 837 with a line item control number, is the line item control number required when adding those lines to the prior claim? This scenario mostly applies to when a provider submits late charges on a subsequent claim. We adjust the original claim by adding those late charges to the original claim. The guide is not clear on adding charges to a prior claim and the values required.
The 005010 X221A1 explicitly addresses this in the 2110 Loop REF Line Item Control Number Segment Situational Rule. It states: required when a Line Item Control Number was received on the original claim or when claim or service line splitting occurred. If not required by this implementation guide, do not send.
The TR3 note also states: This is the Line item Control Number submitted in the 837, which is utilized by the provider for tracking purposes.
Additionally the 005010X222A1 837P explicitly address this in the 2400 Loop REF Line Item Control Number Segment TR3 Note 1: The line item control number must be unique within a patient control number (CLM01). Payers are required to return this number on the remittance advice transaction (835) if the provider sends it to the in the 837 and adjudication is based upon line item detail regardless of whether bundling or unbundling has occurred.
Therefore, the line item control number must be returned on the 835 transaction if it was reported on the 837 claim transaction and based on the rules of the related segments.