Voting Results - IRR CLM900 Benefit Change Reason Code (DNXXXX)
From: Gregg LutzUser Posts: 330 - Intermediate User
Business Requirement / Issue: Provide ability for Trading Partners to report a rate change electronically to comply with 12 NYCRR 300.23(a).
Final Proposed Resolution: Add a new data element to capture Benefit Change Reason Code (DNXXXX).
IRR CLM900 - BENEFIT CHANGE REASON CODE (DNXXXX)
Definition: A code reported at the Claim level identifying the reason the Benefit Type Code or Net Weekly Amount has changed. This is not at the Benefit segment level.
DP Rule: This DN can only be required/reported on a SROI MTC CB - Change in Benefit Type or CA - Change in Benefit Amount. It does not apply to any other SROI MTC's. This should not carry over to future transactions. The jurisdiction should have a current statutory reason for requiring this DN and should be outlined in the jurisdiction's Trading Partner Tables. The data element cannot be Mandatory if the reason for the change in the Net Weekly Amount or Benefit Type Code can be determined by another Data Element elsewhere in the standard.
Values: (To be determined by Systems Committee)
? = Independent Medical Exam (IME) or Claim Administrator Consultant
? = Employee Treating Physician medical report
? = Recalculation of Net Weekly Amount based on Wage Statement
? = Jurisdiction Directed
? = Stipulated or negotiated Net Weekly Amount (not jurisdiction directed)