A 3rd party affiliated with Payer #1 told our client, a Hospital, to send 837Is with 2300: CN101=09 and CN104=the assigned Military Facility ID (MFI) for patients who meet conditions of the Payer ERSA agreement. This is for all ERSA claims, not just for post-adjudicated claims. The 5010 IG says the CN Segment is situational; it is for post-adjudicated claims. The TR3 note says “the CN1 segment doesn’t meet the definition of a health care claim under HIPAA.” We, the vendor, learned ERSA claims are adjudicated by Payer #2 and that Payer #2 and #1 have a 3rd party agreement to ID these claims using the CN101/104 fields. We don’t have an agreement with either payer to do so. Do we need to value the CN101/104 fields for providers having ERSA agreements with Payer #1? We offered to send condition code A0 on ERSA claims (prior method used by Payer #1 to ID ERSA), and Payer #1 or #2 could populate the CN101/104 fields since Payer #1 has a table of providers and their associated MFIs. Our offer has been denied.
As clearly stated in the response to RFI #1671, the CN1 segment is only required for Post Adjudicated claims, and must not be sent if that condition is not met.
A receiver cannot require the submitter to violate the usage requirements of an X12 TR3 with or without a Trading Partner Agreement.