Does a payer (receiver) have the discretion to require the line item control number on all submitted claims? The TR3 situational language seems to indicate that while it is strongly suggested that submitters include, it does not indicate that this element is required nor that receivers and their payer specific companion guides can require this element.
5010 TR3 below:
REF - LINE ITEM CONTROL NUMBER
X12 Segment Name: Reference Information
Loop: 2400 — SERVICE LINE NUMBER
Segment Repeat: 1
Usage: SITUATIONAL
295 Situational Rule: Required when the submitter needs a line item control number for subsequent communications to or from the payer. If not required by this implementation guide, do not send.
Payer Specific 5010 Companion guide: 2400 REF02
Line Item Control Number
The provider MUST submit the line item control number for each service line of a claim.
No, the receiver may not require the submitter to include a line item control number (2400 REF with a 6R qualifier). This data element is sent at the submitter’s discretion.
A receiving entity may not include requirements in a trading partner agreement which override the specification in the implementation guide. See section 1.8 for more information on trading partner agreements. Also companion guides may not add, modify or delete any requirements, including loop, segment or element names, notes or rules, examples, appendix, or code list subsets from Section 2 of the associated TR3. In this case, the receiver could include an explanation as to why the line item control number is desirable but not require it. For more information on companion guides please see the ASCX12 Intellectual Property statement at http://store.x12.org/store/ip-use.