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Back  RFI # 1022: Multiple use of 2120C/D NM1

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Submitter

James Sherwood

Description

Title Multiple use of 2120C/D NM1segments, how to build loop?


When returning in the 271, 2120C or 2120D with multiple NM1s that apply to the same EB segment; are the LS and LE loops segments required for each of the 23 repeats allowed for the 2120C or D loops—or is only a single occurrence of LS and LE segments required?
Example, if an EB*R is being returned with a 2120C and contains 2 NM1s for other payer name and for other payer patient name, respectively.

Should it be:
EB*R~
LS*1~
NM1 [payer name]
NM1 [patient name]
LE*1~

Or

EB*R~
LS*1~
NM1 [payer name]
LE*1~
LS*1~
NM1 [patient name]
LE*1~

Response

This issue is explicitly addressed in guide 005010X279. The LS and LE segment are not inside the 2120C or D loops. They are outside the loop. The LS segment occurs, followed by all related iterations of the 2120C/D loop, and then the LE segment. The LS and LE segments do not occur once per 2120C/D loop iteration of a single 2110C/D loop.

To answer the question of which is correct, the first is correct in structure, but there is one correction to the example provided in the HIR description. The following is the correct response:
EB*R~
LS*2120~
NM1 [payer name]
NM1 [patient name]
LE*2120~
Submission 4/12/2010
Status Date 7/30/2010
Status F - Final
Primary References
Document 005010X279
Section2310C
Page329
Set ID?
Secondary References
RFI ID 926
Document 005010X279
Section2120D
Page432
Set ID?