Change Request Detail
No.
1145
Date
2/4/2011
Submitter
Type of Request
Pertaining to more than one, or not sure
Status
DSMO Process Completed
Business Reason
There are state and federal reporting requirements where the claim encounter transaction should contain payment information.
Suggestion
For all 837 Health Care Claim Transactions, modify the encounter portion of the transaction so it can readily be used to report payment information in the COB loop. There are state and federal reporting requirements where the claim encounter transaction should contain payment information. Currently in Loop 2330, there are segments/loops that are mandatory for COB and should be situational for an encounter.

1. Loops 2330A and 2330B should be situational for encounters and required for COB.

2. The OI segment in Loop 2320 should be situational for encounters and required for COB
DSMO Category
B
Recommendation
Approve. The DSMO recommend the submitter works with X12  for solutions to a future version. Please see the X12 schedule for the October 3-5 meetings for information about an all payer state database joint meeting.

Appeal Recommendation