guides:claim-rules:filing-indicator-override
Table of Contents
Filing Indicator Override
Override the claim filing indicator code (SBR09) on claims. This is a common rejection reason when the wrong filing indicator is sent to a payer.
Applies to: Professional (837P), Institutional (837I), Dental (837D)
When to Use This
- A payer rejects claims with “invalid filing indicator” or similar error
- Your source system sends the wrong filing indicator for a specific payer
- You need to change the filing indicator from one value to another per payer
Fields
| Field | Required | Description |
|---|---|---|
| Start Date | Yes | When this rule becomes active |
| End Date | No | When this rule expires |
| Payer Number | No | Only apply for a specific payer. Blank = all payers |
| Original Filing Indicator | No | Only override if the current value matches. Blank = override regardless of current value |
| New Filing Indicator | Yes | The filing indicator code to set |
| Notes | No | Your reference notes |
Common Filing Indicator Codes
| Code | Description |
|---|---|
| CI | Commercial Insurance Co. |
| MB | Medicare Part B |
| MC | Medicaid |
| OF | Other Federal Program |
| BL | Blue Cross/Blue Shield |
| CH | CHAMPUS (TRICARE) |
| VA | Veterans Affairs Plan |
| WC | Workers' Compensation |
| AM | Automobile Medical |
| HM | Health Maintenance Organization (HMO) |
| ZZ | Mutually Defined |
| 09 | Self-Pay |
| 11 | Other Non-Federal Programs |
| 12 | Preferred Provider Organization (PPO) |
| 13 | Point of Service (POS) |
| 14 | Exclusive Provider Organization (EPO) |
| 15 | Indemnity Insurance |
| 16 | Health Maintenance Organization (HMO) Medicare Risk |
| 17 | Dental Maintenance Organization |
Examples
Example 1: Fix Filing Indicator for BCBS
BCBS rejects claims when the filing indicator is “CI” — they require “BL”.
| Field | Value |
|---|---|
| Payer Number | 00621 |
| Original Filing Indicator | CI |
| New Filing Indicator | BL |
Example 2: Set Medicare Filing Indicator
All Medicare claims should have filing indicator “MB” regardless of what's on the claim.
| Field | Value |
|---|---|
| Payer Number | 00882 |
| New Filing Indicator | MB |
What Happens on the Claim
- Reads the current filing indicator from the SBR segment (element 9) in Loop 2000B
- If Original Filing Indicator is set, only changes it if the current value matches
- Sets the new filing indicator value
- A note is added: “Claim filing indicator changed from {old} to {new}”
- Shows in Applied Validation Modules as “ClaimFilingIndicatorOverrideModule”
guides/claim-rules/filing-indicator-override.txt · Last modified: by brad.sharp