Change Request Detail
No.
840
Date
9/10/2003
Submitter
Type of Request
Claim Status Request and Response
Status
DSMO Process Completed
Business Reason
Currently, Loop 2200E, REF (1K), Payer Claim Identification Number is required.  If a claim cannot be found that meets the search criteria submitted in the inquiry and the inquiry did not contain a REF segment with Payer Claim Identification number, this segment cannot be returned.  You cannot return a claim number if the claim isn't found.
This causes a compliance error a leaves no recourse but to return a "dummy" value in REF02.
Suggestion
277 Transaction: HL 23, Loop 2200E, position 110, change REF (1K) to situational.  Usage notes should indicate, required when a claim meeting the inquiry criteria is successfully located.  If a matching claim cannot be located, the payer claim identfication number submitted in the inquiry (276) should be returned, if submitted.  Otherwise, this segment is not used.

Note:  Usage for HL22, Loop 2200D, position 110, REF (1K) should be the same.

(004010X093, page 122, 165, 210)
DSMO Category
B
Recommendation
Approved.  From X12N: For Version 4050 and beyond, Loop 2200E Payer Claim Identification Number REF has been made Situational. However, in order for the requestor to meet the current syntactical requirements of Version 4010A1, we recommend using a zero (0) in element REF02 when a claim number can not be found or echo back the same number reported in the 276, if one was submitted.
Appeal Recommendation