We are asking from the clearinghouse perspective for clarification around the guidelines for sending the Patient control number in the 276 and 277.
In the 5010 X12 276/277 guidelines, the patient control number section in the request states: Situational: Required when the Patient control number has been assigned by the service provider. If not required by this implementation guide, do not send.
The response section states:
Situational: Required when the Patient Control Number was submitted on the 276 request or when available on claims located in the Information Source’s system. If not required by this implementation guide, do not send.
Our question is whether or not that if a client sends us the Patient control number in their 276, are we required to send it to the payer? Or are we just obligated to return the value in the 277 in which the client sent in the 276, just mirroring back the value?
As you stated, the REF - PATIENT CONTROL NUMBER within the 276 Health Care Claim Status Request is “Required when the Patient Control Number has been assigned by the service provider. If not required by this implementation guide, do not send.” This usage requirement is met by the fact that a Patient Control Number has been assigned by a service provider regardless of the entity sending the 276 transaction. Therefore, when a clearinghouse receives a 276 containing an assigned Patient Control Number from a service provider, the Patient Control Number must be included in the 276 sent to the next receiver.
The REF - PATIENT CONTROL NUMBER must be returned in the 277 if the Patient Control Number was submitted on the 276 request or when available on claims located in the Information Source's system.
The second part of the or condition of the rule allows for situations where the payer returns status for claims that met other criteria submitted by the provider (beyond the Patient Control Number) and the payer would then return the Patient Control Numbers associated with those other claims. In this latter situation, the Patient Control Number for the other claims would not be mirrored or overlaid by the Patient Control Number submitted in the 276.
Please also see RFI #2252 for additional information on Patient Control Number usage in the 277.