A number assigned by the payer to identify a claim in their internal System. The number is usually referred to as an Internal Control Number (ICN), Claim Control Number (CCN) or a Document Control Number (DCN).
Why this number is needed and how useful for processing the claim. Let us understand the workflow first
1) Healthcare entity such as Provider Office, facility, hospital, lab, etc generate the claim for the patient and send to Payer via EDI or CMS 1500.
2) Payer receives the claim, after all the necessary error checking, the claim information will be created into their internal claim processing system. During this process, an unique claim number will be generated in the system for all the future reference.
3) After the claim created in the Payer system , then they determines their financial responsibility for the payment to the provider. This process is referred to as claims adjudication. The insurance company can decide to pay the claim in full, deny the claim, or to reduce the amount paid to the provider.
4) Finally, An explanation of benefits (commonly referred to as an EOB form) is a statement sent to the provider explaining what medical treatments and/or services were paid for on their behalf or why the claim is denied with one or more denied reason codes. Payer specifies their Claim Number both in EOB Paper Form and EDI form (EDI 835).
In case of claim denied, then the servicing entity such as Provider Office, Facility, Hospital, Lab, etc need to correct the claim and re submit the claim again to the Payer. In this process, it is mandatory to include echo back the Payer Claim Number which they they have got from EOB or EDI 835. With this claim Number, payer system can quickly understand that this is existing claim in our process and process the claim and payment can be made.
Please remember, most of the payers will not process your resubmission if you are not putting back their Payer Claim Number.
For example, download the BlueCross BlueShied Payer guidelines for resubmitting the claims with Payer Claim number. Download
How to extract this number from ERA 835 ?
It will be available in CLP segment at the 7th Position as follows
TS3*003448478501*12*20201231*2*96
CLP*143155*19*48*0**HM*20C783340200*12*1
NM1*QC*1*XXXXX*XXXXX M*M***MI*521106302
Here 20C783340200 is the Payer Claim Number.
How to record this number during Manual Posting in PMS Software ?
Typically in the posting screen, we need to provide area to enter this number by poster. Most of the time, a payment poster will ignore this number, so we need to train them on the importance of entering the Payer claim Number and we should make situational mandatory such as when the claim payment is zero, then force the Payment posting team to enter the denied codes along with the Payer Claim Number.
How to put this number back in EDI 837 P when we resubmitting ?
We need put this number back in Loop 2300 Ref Segment. Here is an example.
CLM*214170*64.00***12:B:7*Y*A*Y*Y
REF*F8*185274314700919
How to put this number back in CMS 1500 Paper Form when we resubmitting ?