The 276/277 guidelines indicate that the 277 Loop 2200D, Segment REF with Qualifier 1K is “Required when a claim is located in the Information Source’s system. If not required by this implementation guide, do not send.”
TR3 Notes: “1. This is the payer’s assigned control number, also known as, Internal Control Number (ICN), Document Control Number (DCN), or Claim Control Number (CCN).”
Should the 277 claim status response Loop 2200D, Element REF*1K be populated with the claim number from the host plan 835 remittance advice Loop 2100, Element CLP07 or be populated with the home plan claim number from whom no 835 was received by the provider? Who is considered the information source in the scenario below?
A claim was submitted to the provider’s host plan. The host plan processed the claim according to the provider’s contract provisions and then forwarded it to the home plan for it to be processed according to the patient’s benefits. The host plan produced the remittance advice and included the host plan’s claim number in the 835 Loop 2100, Element CLP07. A 276 claim status request was submitted to the host plan without a claim number included. The claim status 277 response included the home plan’s claim number in Loop 2200D, Element REF*1K, and this number did not match the claim number on the host plan’s 835. The host plan indicated that because the patient’s contract number was not one of theirs, the information returned in the claim status response was from the member’s home plan. The difference in claim numbers can cause confusion for submitting an adjustment claim.
An Information Source is defined as “An entity, typically an insurer or payer, which maintains information regarding the patient’s coverage.” The 276/277 guide (005010X212) does not explicitly require it must be the Payer Claim Control Number assigned by the Information Source.
In order to support the ability for the Information Receiver to locate the most current status information for a claim in this business scenario, it is recommended the control number reported in Loop 2200D/2200E REF*1K match the value returned in the 835 loop 2100 CLP07 element.
Related RFIs: 2328, 1909, 1652