Monday, 2 July 2012

EDI 5010 Documentation 837 Professional - Loop 2300 Claim Information

        

2300 Claim information

Loop Seg ID Segment Name Format Length Ref# Req Value
2300 CLM Claim information ID 3 R CLM
Element Separator AN 1 *
CLM01 Claim Submitter Identifier AN 1/38 1028 R Unique Claim Number
Element Separator AN 1 *
CLM02 Monetary Amount R 1/18 782 R Total Charges
Element Separator AN 1 *
CLM03 Claim Filling Indicator       Not Used  
Element Separator AN 1 *
CLM04 Non Institutional Claim Type       Not Used  
Element Separator AN 1 *
CLM05-1 Facility Code Value AN 1/2 1331 R Place of Service Code
Component Element Separator   :
CLM05-2 Facility Code Qualifier ID 1/2   R B
Component Element Separator   :
CLM05-3 Claim Frequency Type Code ID 1 1325 R 1 = Original
7 = Replacement
8 = Void
Element Separator AN 1 *
CLM06 Yes/No Provider Signature on File ID 1 1073 R Y
Element Separator AN 1 *
CLM07 Provider Accept Assignment Code ID 1 1359 R A = Assigned
B = Assignment Accepted on Clinical Lab Services Only
C = Not Assigned
Element Separator AN 1 *
CLM08 Yes/No Assignments of Benefit ID 1 1073 R Y
Element Separator AN 1 *
CLM09 Yes/No Release of Information ID 1 1363 R Y
Element Separator AN 1 *
CLM10 Patient signature source code ID 1 1351 S P
Element Separator AN 1 *
               
               
               
               

Examples:

CLM*249*60***11:B:1*Y*A*Y*Y

CLM*250*38***11:B:1*Y*A*Y*Y

********************************************************************************


CLM5- Claim Frequency Codes
Code Definition
1 Indicates the claim is an original claim
7

Indicates the new claim is a replacement or corrected claim. The information present on this bill represents a complete replacement of the previously issued bill.

8 Indicates the claim is a voided/cancelled claim

 

REPLACEMENT CLAIMS

Replacement claims submitted electronically will reduce the potential for a claim to deny as a duplicate. If a replacement claim needs to be submitted, you may submit the correction electronically with the appropriate frequency code (7).

An example of the ANSI 837P file containing a replacement claim, along with the required REF segment and Qualifier in Loop ID 2300 – Claim Information, is provided below.

CLM*12345678*500***11::7*Y*A*Y*I*P~
REF*F8*(Enter the Claim Original Reference Number)

The first two digits (“11”) in the example above indicate the place of service on a professional claim. The colons (“::”) between the place of service and frequency code are known as Sub element Separators (indicates that this field is currently not used).

The replacement claim will replace the entire previously processed claim. Therefore, when submitting a correction, send the claim with all changes exactly how the claim should be processed.

Examples:
1. A claim was previously submitted with procedure codes 99213, 88003 and 77090. The 88003 should have been 88004. An electronic replacement claim should be submitted for the line that needs to be corrected, along with the appropriate frequency code: 7, 99213, 88004 and 77090. This indicates to BCBSIL that all charges need to be deleted, and the claim will then be processed with 99213, 88004 and 77090.

2. A claim was previously submitted with procedure codes 99214, 70052 and 99213. Procedure codes 70052 and 99213 were submitted in error and need to be removed. An electronic replacement claim should be submitted with frequency code 7 and procedure code 99214. This claim will then be adjusted to remove 70052 and 99213, and it will be processed with 99214.


Example : 2
Claim Setup

Field

Value

Claim No

252

Claim Location

NY Office

Place of Service

11 - Office

Rendering Provider

David Mark

ICD Code

410,415, 368.34, 522.3

Line items

Procedure Code

Mod1

Mod2

Mod3

Mod4

ICD

FromDOS

ToDOS

Units

Unit Charges

99214

1,2,3,4

01/09/2012

01/09/2012

1

40

92570

1

01/09/2012

01/09/2012

1

180.04

90371

3,4

01/09/2012

01/09/2012

1

83


CLM*252*303.04***11:B:1*Y*A*Y*Y~

By Loop
2300 - Claim Information CLM CLM*252*303.04***11:B:1*Y*A*Y*Y~
2300 - Claim Information - Clia Number REF REF*X4*CL324234~
2300 - Claim Information - ICDs HI HI*BK:410*BF:415*BF:36834*BF:5223~
2310B - Rendering Provider Name NM1 NM1*82*1*Mark*David****XX*1111111111~
2310D - Service Facility Location NM1 NM1*77*2*NY Office*****XX*1336177328~
2310D - Service Facility Location N3 N3*5081 Tellus. Avenue*668-2204 Non Rd.~
2310D - Service Facility Location N4 N4*White Plains*NY*809051232~
2310D - Service Facility Location REF REF*LU*484345~
2400 - Service Line LX LX*1~
2400 - Service Line SV1 SV1*HC:99214*40*UN*1*11**1:2:3:4~
2400 - Service Line DTP DTP*472*RD8*20120109-20120109~
2400 - Service Line REF REF*6R*1140~
2400 - Service Line LX LX*2~
2400 - Service Line SV1 SV1*HC:92570*180.04*UN*1*11**1~
2400 - Service Line DTP DTP*472*RD8*20120109-20120109~
2400 - Service Line REF REF*6R*1141~
2400 - Service Line LX LX*3~
2400 - Service Line SV1 SV1*HC:90371*83*UN*1*11**3:4~
2400 - Service Line DTP DTP*472*RD8*20120109-20120109~
2400 - Service Line REF REF*6R*1142~





        

Questions or feedback are always welcome. You can email me at vbsenthilinnet@gmail.com.
 

1 comment:

  1. What if claims has more than 100 claims how do we go about it? I see that claims can have only up to 99. We have more than 100 here

    ReplyDelete