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Back  RFI # 1002: 5010 Implementaion Query

Formal vs. Informal Help Informal Formal

Submitter

Deepti Dabral

Description

New Loop 2010AC: Situational Rule says “Required when willing trading partners agree to use this implementation for their subrogation payment requests.” We didn’t get this at all. What does this sentence mean? Can you please elaborate in what conditions this loop is needed?

Do we have to confirm with each and every payer whether they need this loop or not? Or is there any standard condition that needs to be checked to generate this loop?

Response

This issue is explicitly addressed in guide 005010X222. Section 1.4.1.5 (Coordination of Benefits - Medicaid Subrogation) describes the business of subrogation. Subrogation is a payer to payer business transaction, when both payes agree to the transaction and one of those payers is a Medicaid agency. Subrogation does not involve providers as trading partners.
Submission 3/25/2010
Status Date 4/26/2010
Status F - Final
Primary References
Document 005010X222
Section2.4
Page99
Set ID837