I have a question about when to send the value 'I' in CLM-09 of the 2300 loop and/or OI-06 in the 2320 loop on professional claims. According to both the 4010 IG and the 5010 TR3:
I = Informed Consent to Release Medical Information for Conditions or Diagnoses Regulated by Federal Statutes
The 5010 TR3 also states that the value 'I' is required when the provider has not collected a signature AND state or federal laws do not require a signature be collected.
Reading the explanation in the TR3 leads me to the conclusion that what is sent in CLM-09 is not related to the diagnosis on the claim. It merely reflects what type of patient consent was received. I have a payer that is editing the CLM-09 and based on the claim's diagnosis code is rejecting the claim if CLM-09 is not 'I'. Is this an appropriate edit?
In both 4010A1 and 5010 versions of the 837P, the value of CLM09 is not related to a specific diagnosis. CLM09 is used to report whether the submitter has the right to release the information on the claim and how the consent was obtained. The only valid values under the HIPAA Privacy rule are Y and I.