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Medicare Billing: CMS-1450 & 837I

Loop 2300 REF/FL 64 A-C

situationally required icon

Medicare requires when the claim is an adjustment, void, or cancel claim.

Table 44: Loop 2300 REF/FL 64 A-C Fields
Document Control NumberSource
When re-submitting an adjusted, void, or cancelled claim, enter the original claim’s Document Control Number (DCN). The DCN is a unique number that a MAC assigns a claim.Remittance advice of the original claim being adjusted or cancelled

To replace, void, or cancel a claim, include the DCN from the remittance advice that shows Medicare's payment for the original claim on the adjusted, voided, or cancelled claim.