What is a Payer Claim Control Number/ICN Number?
A Payer Claim Control Number indicates the claim is a replacement or void to a previously adjudicated claim. The Payer Claim Control Number changed from ‘Situational’ to ‘Required’ in 5010.
When does this exclusion happen?
This exclusion occurs when a claim is trying to be re-billed to a payer marked as corrected but without the original reference number.
How to tell if a claim is being marked as corrected.
How do I add the ICN number.
Why is this option available?
Typically, a claim will be marked as corrected if the payer is requesting the claim be re-billed to them as a corrected claim. The Original Reference number is the ICN number on the EOB from the payer.
However, most claims do not need to be marked as a corrected claim if being sent to the payer a second (or even third or more) time.
Why most claims do not need this.
The AdvancedMD billing system auto generates a letter at the end of the visit number. Ex: 1234A, the A tells the payer that this is the first time the claim has been billed to them. If they send it back with a rejection, or the Clearinghouse sends the claim back with an exclusion, the second time the claim is billed out it will go out as 1234B. Each time the claim is rebilled, the letter changes to the next letter in the alphabet.
How is this exclusion fixed?
To fix this exclusion, determine if you are truly billing a corrected claim or not. If it is a corrected claim, find the ICN number off of the EOB and insert the ICN number into the Original Reference # field. If this claim does not need to go out as correct, simply un-check the Correct Claim box, and select re-bill.
*Note: Medicare does not accept corrected claims at all.
What does this exclusion look like?
From Relay Health’s Exclusion Claims Report:
AM PREF0201:MISSING PAYER CLAIM CONTRL NUMB
Thanks to Trisha B. for putting this article together.