To build on RFI 1799 and 1945. If a replacement claim is received (CLM05-3 = 7) with a different patient control number (CLM01) than the original claim and no other data is different, what value is returned in the CLP01 of the 835 when adjudicating the replacement claim? Possibly the provider submitted the claim originally under the wrong patient account number. What would be the proper way to “replace” an original claim with a new claim where the only change to the original claim is the patient control number (CLM01)?
Correcting an incorrect patient control number (CLM01) cannot be accomplished by sending a replacement claim with only a different CLM01 value when the original claim is otherwise a duplicate. A receiver (payer) would not be able to identify and tie the replacement claim to the original claim based solely on such a change. Even if a receiver (payer) could do this, there would be potential conflicts in the submitters system when receiving any resulting 835 transaction based on the CLP01 note which reads in part “The value in CLP01 must be identical to any value received as a Claim Submitter’s Identifier on the original claim (CLM01 of the ANSI ASC X12 837, if applicable).”
To replace an original claim where the only piece of data that is changing is the patient control number, a voided claim should be sent with CLM05-3 = 8 with the original patient control number. A subsequent original claim would then be sent with CLM05-3 =1 with the new patient control number. The 835 in response to the new original claim would contain the new patient control number in the CLP01.