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5010 276 Implementation Guide Question? RRS feed

  • Question

  • Hi there

    I know this is probably not the best place to post but I figured someone here would know?

    This is for a 5010 276 transaction

    The Claim Number on the Ref 1K segment is situational but I can not determine which other field makes it required?

    Ref 1K 123456789 is required  when what is required?  I have a case test where 123456789 needs to be removed

    REF - PAYER CLAIM CONTROL NUMBER
    X12 Name: Reference Information
    X12 Purpose: To specify identifying information
    X12 Syntax:
    1. R0203
    At least one of REF02 or REF03 is required.
    Loop:
    2200D OR 2200E— CLAIM STATUS TRACKING NUMBER
    Segment Repeat:
    1
    Usage:
    SITUATIONAL
    Situational Rule:
    Required when the Information Receiver knows the payer assigned number and intends the search criteria be narrowed to a specific claim. 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).
    TR3 Example:
    REF1K9918046987~

    Thanks!

    • Moved by Ben Cline1Moderator Thursday, October 14, 2010 3:27 AM Related to EDI (From:BizTalk Server General)
    Tuesday, October 12, 2010 8:48 PM

Answers

  • If the REF segment exists and REF01 is equal to 1K then REF02 is required.

    If 123456789 is removed (ex : REF*1K) then the file should fail HIPAA Compliance Error.

    Sathish - http://blog.tsathish.com
    Thursday, October 14, 2010 7:07 AM