Section title: Requests for Interpretation
RFI #
2367
Origninal Claim definition
Description

RFI 1799 and 1945 seem to imply that the term 'original claim' refers to the first claim submitted for a set of procedures, and that corrected claims that amend/replace the original claim are not themselves considered original claims. If that is true, some of the intended use cases of 'original claim' data throughout the 837/835 specs become unclear. Can you please clarify how 'original claim' should be interpreted (along with intended use of the examples below)?
E.g. in an 835, 2400-REF*6R is required "when a line item control number was received on the original claim..". Does this mean a provider should not expect to receive REF6R for a new claim line added on a replacement claim (relevant to, but not present on, the original submission)?
E.g. in an 835, 2400-REF*6R is required "when a line item control number was received on the original claim..". Does this mean a provider should not expect to receive REF6R for a new claim line added on a replacement claim (relevant to, but not present on, the original submission)?

Response

The original claim is the most recent adjudicated version of the claim. For every segment/element note, the business use determines the original claim reference. The intent of the word 'original' in the 835 refers to the current claim being responded to.

DOCUMENT ID
005010X221