Change Request Detail
Type of Request
Payment of a Health Care Claim
DSMO Process Completed
Business Reason
This issue concerns the 5010 837 Professional TR3. CMS requested changes be made to the next version of the 837P IG regarding Loop 2320 SBR05. Specifically, CMS requested that the values in 2320 SBR05 match the values in the 2000B SBR05 with multiple repeats allowable. Although the values have been added to the 2320 SBR05 in the 5010 TR3, a usage note, which in essence precludes the data from ever being submitted on an inbound Medicare claim, was also added. TG2 WG2 co-chairs have been consulted on this issue and acknowledge that the requested change was not implemented as they had understood the request. Because of that, CMS is requesting that an official statement and/or guidance be issued which allows CMS to use the 2320 SBR05 in the manner in which it was intended to be used per our original request.    
Request that the 2320 SBR05 be allowed to be submitted on claims when Medicare is the destination payer, not other payer.
DSMO Category
Disapprove. The submitted "Suggested Change" is not a request for change but a request for an exception. The DSMO ask that the submitter resubmit with a clear request to make a change to a future TR3.
Appeal Recommendation