Problem:  Changes in 5010 for status inquiry

Answer:  2300 CLM 5-03 can no longer have a value of “6” for a status inquiry. “6” was removed in the 5010 standard which is designated in our program as “CORRECTED CLAIM – POTA NOT IN MICHIGAN”. The value “7” should now be used which is “REPLACEMENT OF PRIOR CLAIM”. I will write this up as a bug and it will be corrected in the version following 4.15 .

Corrections and Reversals

The 837 TR3 defines what values submitters must use to signal to payers that the inbound 837 contains a reversal or correction to a claim that has previously been submitted for processing. For both Professional and Institutional 837 claims, 2300 CLM05-3 (Claim Frequency Code) must contain a value from the National UB Data Element Specification Type List Type of Bill Position 3. Values supported for corrections and reversals are:
5 = “Late Charges Only” Claim
7 = Replacement of Prior Claim
8 = Void/Cancel of Prior

ClaimChapter 2: 837 Professional Health Care Claim
BCBSNC Companion Guide to X12 5010 transactions – 837 Professional Health Care Claim v.2.9 3 © BCBSNC, 2010. Unauthorized copying or use of this document is prohibited.
Data Retention of Denied Claims
Data from claims that are denied is retained for a minimum of three years before archiving. This data is available electronically for eighteen months before archiving. After eighteen months, inquiries should be restricted to telephone inquiries only.