RFI #
2229
Tertiary claim with no primary
Description
We have a claim for a tertiary payer (Loop 2000B, SBR01 = T), but on Loop 2320, there is no information about a primary payer, only secondary. Our validator rejected the claim due to the missing information for the primary payer. On a previous response (RFI 1151), it was stated that is was not required to send the payers that are not involved in paying the claim, Would that apply even if it is the primary payer? Should there always be an instance of primary payer on Loop 2320 when the claim is sent to a tertiary or other subsequent payer?
RFI Response
No, a payer is only included on a claim if the payer is involved in payment. If the primary payer was not involved in payment then it can be omitted
DOCUMENT ID
005010X224