Section title: Requests for Interpretation
RFI #
2307
837i Loop 2300, Segment CN1
Description

State Medicaid providers submit X12 837i transaction for Nursing Home Fee for Service Claims (FFS) and Encounter transactions. These are priced according to Level of Care which is obtained from Loop 2300, Segment CN1 04.

Response

The Loop 2300 CN1 segment Situational Rule and TR3 Note would not allow the usage of the CN1 segment as you describe. They state the following:

Situational Rule: Required when the submitter is contractually obligated to supply this information on post-adjudicated claims. If not required by this implementation guide, do not send.

TR3 Note: 1. The developers of this implementation guide note that the CN1 segment is for use only for post-adjudicated claims, which do not meet the definition of a health care claim under HIPAA. Consequently, at the time of this writing, the CN1 segment is for non-HIPAA use only.

RFI Recommendation

The Loop 2300 NTE Billing Note segment can be used if this condition is met. ” Required when in the judgment of the provider, the information is needed to substantiate the medical treatment and is not supported elsewhere within the claim data set.”

If you have a business need not supported in a published TR3, you may submit an ASC X12 change request for consideration in a future version of the TR3. Change requests are submitted at http://changerequest.x12.org/

Please also see RFI’s, 1130, 1336, 1671, 1760, and 2295.

DOCUMENT ID
005010X223