A Payer Claim Number, also known as an Internal Control Number (ICN), Claim Control Number (CCN), or Document Control Number (DCN), is a unique identifier assigned by a payer to track a claim within their internal system.
Significance of the Payer Claim Number in Claim ProcessingTo fully understand the role of this number, let’s go through the typical claim processing workflow:
- Healthcare entities such as provider offices, facilities, hospitals, and laboratories generate claims for patients and submit them to payers via Electronic Data Interchange (EDI) or paper claims (CMS-1500 form).
- Upon receipt, the payer validates the claim, performs necessary error checks, and enters the claim into their internal processing system. At this stage, a unique claim number is generated for future reference.
- The payer then determines their financial responsibility through a process known as claims adjudication. The claim may be approved for full payment, partially paid, or denied based on coverage and policy rules.
- An Explanation of Benefits (EOB) is then issued to the provider, detailing the payment decision and any applicable denial reason codes. The payer includes the Payer Claim Number in both the EOB (paper format) and the Electronic Remittance Advice (EDI 835).
When a claim is denied, the healthcare provider must correct and resubmit it for reconsideration. In this process, the inclusion of the original Payer Claim Number—as provided in the EOB or EDI 835—is mandatory.
This number allows the payer’s system to quickly recognize that the claim is a resubmission rather than a new claim, facilitating efficient processing. Most payers will not accept resubmissions that do not reference the original Payer Claim Number.
For detailed submission guidelines, refer to specific payer instructions such as the BlueCross BlueShield resubmission policy, which mandates the inclusion of the Payer Claim Number.
How to Retrieve the Payer Claim Number from an ERA 835 FileThe Payer Claim Number can be located in the CLP segment of the ERA 835 file at the 7th position. Below is an example:
TS3*003448478501*12*20201231*2*96 CLP*143155*19*48*0**HM*20C783340200*12*1 NM1*QC*1*XXXXX*XXXXX M*M***MI*521106302
In this case, 20C783340200 is the Payer Claim Number.
Best Practices for Recording the Payer Claim Number in PMS SoftwareMost Practice Management Software (PMS) solutions include a designated field for entering the Payer Claim Number during manual payment posting. However, payment posters often overlook this field, leading to inefficiencies in claim tracking.
To ensure accuracy:
- Train payment posting teams on the importance of capturing this number.
- Implement a system validation that requires entry of the Payer Claim Number when processing denied claims.
- For claims with zero payments, enforce the entry of both denial codes and the Payer Claim Number before finalizing the posting.
When resubmitting a claim via EDI 837P, the Payer Claim Number must be inserted in Loop 2300 REF Segment. Below is a sample format:
CLM*214170*64.00***12:B:7*Y*A*Y*Y REF*F8*185274314700919
Here, REF*F8*185274314700919 references the original Payer Claim Number within the EDI 837P file.
ConclusionBy ensuring that the Payer Claim Number is accurately recorded and referenced during claim resubmissions, healthcare providers can significantly improve the efficiency of their claim processing and reduce unnecessary denials. Compliance with payer-specific guidelines is key to seamless reimbursement.