Section title: Requests for Interpretation
RFI #
2370
PLB0302 usage CLP01 and CLP07
Description

In regard to reference ID usage in the PLB for the 835, RFI # 484: PLB03-2 Reference Identifier response states: If there is no financial tracking number on the payer correspondence to the provider then the WG recommends including a combination of CLP01 and CLP07 or use only one of these elements, if available. We would like clarification: Can we include CLP01 in addition to CLP07 in the Reference ID for WO and FB?

Response

Section 1.10.2.17 Claim Overpayment Recovery section describes the use of the PLB and reference IDs to be used. In option 3, the TR3 states “The FCN reported would be the health plan’s internal number for the claim involved in the recovery (CLP07).” This is to be reported in PLB03-2 when PLB03-1 is WO for overpayment recovery.

RFI Recommendation

Because providers need to associate the amount with their claim, the provider’s claim ID from CLP01 is needed to be reported in the Reference ID of the PLB as well as the payer claim ID in CLP07. The intention of the TR3 was to provide a link for the provider to tie the adjustment back to the claim. Reporting the additional detail of CLP01 and CLp07 in the REF ID is acceptable as long as TRN02 is included. The authors recommend reporting the claim identified in the order of CLP01, CLP07 and TRN02. In the event that the reference ID exceeds the maximum characters when reporting values, limit the CLP01 to the 1st 35 characters. The payer should also include this in their 835 companion guide.

DOCUMENT ID
005010X221A1