Claim Frequency Code (CLM05-3)

Overview

There is a need for the correct Claim Frequency Code to be sent in Loop 2300: CLM05-3. Currently there's a claim INI setting that can be used for this but it's extremely limited in what it can do.

 

What's New

There is now a drop down list added to the Edit Episode screen giving the user control over which code is sent per claim. 

 

 

 

There is also a new option "3" for the Use Claim Frequency Code in the Form Setup screen.

 

 

 

Instructions

Open DClaim

Click the Batch Claims tab

Select Form Manager

Click Primary Setup button to open Form Setup screen.

Select Use Claim Frequency Code from the Property Name dropdown list.

Enter 3 in the Property Value field.

Select Claim Frequency Rebill Code from the Property Name dropdown list.

Enter 7 (or desired Claim Frequency Code) in the Property Value field.

Click the Add/Modify button.

 

When the "Use Claim Frequency Code=3" the Claim Frequency Code will default to the value of Form setting "Claim Frequency Rebill Code" when an REF*F8 segment identifier (either via Certificate1 or Reference ID Type F8 Claim Original Reference Number (ICN/DCN) in the Addl. Dates/IDs screen) has been specified AND the Claim Frequency Code has not been explicitly specified in the Edit Episode screen.  When a Claim Frequency Code has been specified in the Edit Episode screen, that code will always be used on the claim.

 

Use Claim Frequency Code= 0/1/2/3 (default 0)

 

Frequency Code: The appropriate Frequency Code must be present on 837 transactions to indicate the information submitted is for a claim adjustment.

 

Professional claim adjustment submissions:

 

The Frequency Code (values 7 for replacement/corrected claims or 8 or voided claims) associated with the Place of Service indicates this transaction is an adjustment.

 

Claim Note: Professional claim electronic adjustment requests must include the Adjustment Reason and Narrative explaining why the claim is being adjusted. (Example: Adjustment Reason: Number of units; Narrative: Units billed incorrectly, changed units from 010 to 001).

 

Original Reference Number (ORN): All 837 electronic adjustment transactions must include the claim number of the originally adjudicated claim found on your remittance advice (i.e., the ICN/DCN of the claim you want adjusted)