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Back  RFI # 1036: Pay-To-Plan Loop 2010AC

Formal vs. Informal Help Informal Formal

Submitter

Matthew Mecham

Description

When would this be used? Please give an example. I assume this would be on a claim by claim basis?

Response

The 2010AC Pay to Plan Loop is only used when the transaction type (BHT06) is 31 Subrogation Demand. At this time, Subrogation Demand is not a HIPAA mandated use of the 837 transaction. Section 1.4.1.5 (Coordination of Benefits - Medicaid Subrogation) identifies the business usage of the 2010AC loop. The 2010AC loop situational rule reads "Required when willing trading partners agree to use this implementation for their subrogation payment requests."

In another HIR, (HIR 772) X12N recommended usage of this transaction type and loop to address the business scenario of a “Factoring Agent”. Please refer to HIR 772 for the particulars of this business usage.
Submission 5/3/2010
Status Date 7/30/2010
Status F - Final
Primary References
Document 005010X222
Section2010AC
Page106
Set IDAll