Payer Claim Control Number & Original Reference Number

When a previously processed medical claim needs to be replaced, corrected or voided, the payer generally needs a way to identify the specific prior claim that the new submission references.

This identifier may be described as a Payer Claim Control Number, Original Reference Number, original claim number or another payer-specific term.

Although these terms can appear confusing, they commonly serve a similar purpose in the claim correction process: identifying the prior claim within the payer's system.

The exact terminology, location and requirements can vary by health plan, payer, program and claim type. Always follow the health plan's current claim correction, replacement and void instructions for the specific claim.

What Is a Payer Claim Control Number?

A Payer Claim Control Number is generally a claim identifier assigned by the payer or receiving organization.

Once the payer has assigned an identifier to a claim, that number can be used to reference the claim in later transactions or claim-processing activities, depending on the payer's systems and requirements.

This becomes especially important when a provider needs to tell the payer:

• which previously processed claim should be replaced
• which previously processed claim should be voided or canceled
• which claim is being referenced in a claim correction or adjustment workflow

Think of the payer claim control number as an identifier that helps the payer locate the prior claim in its own claim-processing system.

What Is an Original Reference Number?

The term Original Reference Number is commonly encountered when submitting a claim that references a prior claim.

For professional claims submitted on the CMS-1500/HCFA-1500 form, Box 22 contains fields for the Resubmission Code and Original Reference Number.

When the health plan requires Box 22 for a replacement or void claim, the Original Reference Number generally identifies the prior claim being referenced.

For example, the health plan may instruct the provider to report:

• Claim Frequency Type Code 7 when replacing a prior claim
• the payer's claim number for that prior claim as the Original Reference Number

For a void or cancel submission, the health plan may similarly require:

• Claim Frequency Type Code 8
• the payer's claim number identifying the claim that should be voided

For more information about the professional claim form, see our HCFA-1500 Box 22 - Resubmission Code and Original Reference Number guide.

Payer Claim Control Number vs. Original Reference Number

In replacement and void claim workflows, the terms Payer Claim Control Number and Original Reference Number are closely related.

The terminology may differ depending on whether you are looking at a paper claim form, an electronic transaction, a payer portal, a remittance or billing software.

The important concept is not simply the name of the field. The provider needs to determine which identifier the health plan requires to reference the prior claim.

Is the Payer Claim Control Number the Same as Your Patient Account Number?

Not necessarily, and generally these should be treated as different identifiers.

A provider may assign its own identifier to a claim or patient account. That identifier helps the provider track the claim within its billing, practice management or patient accounting system.

The payer may separately assign its own claim identifier after receiving or processing the claim.

Why Is the Payer Claim Control Number Important?

When a provider submits a replacement or void claim, identifying the type of submission is only part of the information the payer may need.

For example, Claim Frequency Type Code 7 generally tells the payer that the submission is intended to replace a prior claim.

But the payer also needs to determine which prior claim is being replaced.

The same general concept applies to a void submission using Claim Frequency Type Code 8: the frequency code indicates the intended action, while the payer-assigned claim identifier helps identify the prior claim to which that action applies.

Exact requirements vary, so providers should always verify the health plan's current instructions before submitting a replacement or void claim.

How Is the Payer Claim Control Number Used With Code 7?

Claim Frequency Type Code 7 is generally used to identify a Replacement of Prior Claim.

When a health plan requires a replacement claim, the provider may also need to report the payer's claim control number or original claim number so the payer can associate the replacement submission with the appropriate prior claim.

For more information about replacement claims, see our Claim Frequency Type Code 7 - Replacement of Prior Claim Explained guide.

How Is the Payer Claim Control Number Used With Code 8?

Claim Frequency Type Code 8 is generally used to identify a Void/Cancel of Prior Claim.

Because the payer needs to determine which prior claim should be voided, the payer's claim identifier may also be required with the void submission.

For more information about void claims, see our Claim Frequency Type Code 8 - Void/Cancel of Prior Claim Explained guide.

Where Can You Find the Payer Claim Control Number?

The location of the payer's claim number can vary by health plan and by the systems used to submit and receive claim information.

Depending on the payer and claim workflow, the identifier may be available from sources such as:

• the payer's remittance or Explanation of Payment
• an Electronic Remittance Advice (ERA/835)
• the payer's provider portal
• claim status information
• certain electronic claim acknowledgment or status transactions
• clearinghouse claim history or claim-status information

The name displayed may not literally be Payer Claim Control Number. A payer or software application may display a term such as Claim Number, Claim ID, Original Claim Number, DCN, ICN or another identifier.

Can the Payer Claim Control Number Be Found on an 835 ERA?

Depending on the payer and transaction, the payer-assigned claim identifier may be available on the 835 Electronic Remittance Advice (ERA).

This can make the ERA an important source when researching a previously adjudicated claim that now needs correction or other follow-up.

However, providers should not assume that every identifier displayed by billing software or on a remittance is the number required for a replacement or void submission. Verify the appropriate identifier using the health plan's instructions and the information available for the specific claim.

Can a Claim Status Response Contain the Payer's Claim Number?

Depending on the payer and claim-status workflow, claim status information may include a payer-assigned claim identifier.

This can be helpful when researching the status of a claim and determining whether a payer claim number has been assigned.

However, not every acknowledgment, status response or claim-processing stage will necessarily contain the identifier needed for a later corrected, replacement or void claim.

The presence and use of the identifier should therefore be verified before using it as the Original Reference Number on a new submission.

Payer Claim Control Number on the HCFA-1500 / CMS-1500

For professional paper claims, replacement and void information may be reported in Box 22 of the CMS-1500/HCFA-1500 claim form when required by the health plan.

Box 22 contains two related pieces of information:

A common replacement-claim example would therefore contain:

• Resubmission Code 7
• the payer-assigned claim number for the prior claim in the Original Ref. No. field

A void submission may similarly use Code 8 with the appropriate payer-assigned identifier.

These are general examples. The health plan's current claim submission instructions should always be reviewed before completing Box 22.

Payer Claim Control Number on an Electronic 837P Claim

For an electronic professional claim using the X12 837P transaction, the payer claim control number is commonly associated with the 2300 Claim Information Loop.

At a high level, a replacement or void submission may contain:

• the applicable Claim Frequency Type Code in the claim information
• a reference identifying the payer's prior claim.

This article focuses primarily on understanding the identifier and its role in the claim workflow. For a more detailed example showing the relationship between Box 22 and the electronic 837P transaction, see our HCFA-1500 Box 22 - Resubmission Code and Original Reference Number guide.

Payer Claim Control Number vs. Patient Account Number

It is especially important not to confuse the payer claim control number with the Patient Account Number used on a professional claim.

Even if both numbers appear on a remittance, claim-status screen or billing system, they serve different purposes.

What If You Cannot Find the Payer Claim Control Number?

If a health plan requires its original claim number for a replacement or void submission and you cannot identify the correct number, avoid guessing or substituting another identifier simply because it is available.

Instead, review the health plan's resources for locating the prior claim. Depending on the payer, this may involve:

• reviewing the remittance for the original claim
• checking the provider portal
• reviewing electronic claim-status information
• reviewing clearinghouse claim history
• contacting the health plan or following its provider-support process

Using the wrong identifier may prevent the payer from correctly associating the new submission with the intended prior claim.

What If the Original Claim Was Rejected?

A payer claim control number is especially relevant when referencing a prior claim that exists in the payer's claim-processing system. A claim that was rejected before adjudication may need to be handled differently.

If a submission was rejected, first determine where the rejection occurred and follow the applicable health plan or clearinghouse instructions for correcting and resubmitting the claim.

In many workflows, a rejected claim is corrected and resubmitted as an Original Claim using Claim Frequency Type Code 1, rather than being submitted as a replacement of a previously adjudicated claim.

For more information, see our Can You Resubmit a Rejected Medical Claim? guide.

Common Payer Claim Control Number Mistakes

Payer Claim Control Number Examples

Example 1: Replacement Claim

A provider determines that information on a previously adjudicated claim needs to be corrected. The health plan instructs the provider to submit a replacement claim.

The provider may need to submit Claim Frequency Type Code 7 along with the payer-assigned claim number identifying the prior claim.

Result: The frequency code indicates that the submission is a replacement, while the payer claim control number identifies the prior claim being referenced.

Example 2: Void Claim

A provider determines that a previously processed claim needs to be canceled. The health plan instructs the provider to submit a void claim.

The provider may need to submit Claim Frequency Type Code 8 and the payer-assigned identifier for the claim that should be voided.

Result: The frequency code indicates the requested action, while the payer claim control number identifies the prior claim.

Example 3: Wrong Number Selected

A billing system displays both the provider's patient account number and the payer's claim number. The provider is preparing a replacement claim.

Instead of assuming either number is correct, the provider reviews the health plan's corrected-claim instructions and confirms which payer-assigned identifier should be reported.

Result: The provider avoids confusing an internal account identifier with the payer's required original claim reference.

A Simple Way to Think About It

This is a useful conceptual framework, but it should not replace the health plan's specific billing instructions. Always verify the required claim frequency code, original claim identifier, submission method and any additional requirements before submitting a replacement or void claim.

Frequently Asked Questions

Important: Claim correction, replacement, void and original-reference-number requirements can vary by health plan, payer, program and provider contract. The terminology and examples in this guide provide general educational information. Always follow the health plan's current claim submission and correction requirements for the specific claim and situation.

For technical requirements related to electronic professional claim submissions using the X12 837P transaction, refer to the official implementation guides published by X12 and the applicable payer companion guide.