In reviewing RFI 1278 (version 5010), it is clear that this REF Payer Claim Control number can be sent with frequency codes 7 and 8. There is a new frequency code Q - claims submitted for reconsideration/reopening outside of timely limits (effective 1/1/2016)
Would frequency code Q, be consider valid for using the Loop 2300, REF01=F8?
The 837I 005010X223A2, 2300 REF Payer Claim Control Number situational rule states 'Required when CLM05-3 (Claim Frequency Code) indicates this claim is a replacement or void to a previously adjudicated claim'. The rule does not specify which Claim Frequency Code values are considered to be “replacement” or “void” to a previously adjudicated claim.
Frequency Code Q is used for reopening/reconsidering a final determination or decision on a previously adjudicated claim that is outside of a payer's timely filing limits. When a provider submits a 'reopening/reconsideration' within the timely filing period, the provider would send a replacement claim (code value 7). A re-opening that is outside the timely filing limits could be considered a “replacement” claim and therefore reporting the Loop 2300, REF01=F8 would be appropriate and useful to the payer.