Loops and Segments Table – Loop 2300 – Claim Information

Contract Information

Usage : Situational
Element : CN101
Value :
01 = Diagnosis Related Group (DRG)
02 = Per Diem
03 = Variable Per Diem
04 = Flat
05 = Capitated
06 = Percent
09 = Other

Comment :Code to identify a contract type.

Usage : Situational
Element : CN102
Value : Nil
Comment : The amount of the contract agreement (Obligated to Accept as Payment in Full Amount).

Claim Rejections for Invalid/Incomplete Information Submitted in the UTN Field

Palmetto GBA will reject claims when information is entered into the Prior Authorization fields (the 2300 – Claim Information Loop or 2400 Service Line Loop and the Prior Authorization reference (REF) segment, REF02 data element, and the corresponding REF01 data element field) when the information entered is not applicable to the intended use of these fields. Populating these loops and segments for other purposes is incorrect.

Applicable rejections will appear on remittance noticed with:

CARC 15 – The authorization number is missing, invalid, or does not apply to the billed services or provider

Remarks codes:

N704 – Alert: You may not appeal this decision but can resubmit this claim/service with corrected information if warranted;

N517 – Resubmit a new claim with the requested information