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Back  RFI # 1061: 278 X217 Use of the 2000 UM01

Formal vs. Informal Help Informal Formal

Submitter

Chris Meisner

Description

I question the use of the 2000F UM seg. in the X217 IG. The HLSS sit. rule states:"Required when specific services are associated with this patient event. If not required by this implementation guide, do not send." One has to assume that if the submitter is requesting any review of a svc, the 2000F loop is required. The UM seg. is sit. at the 2000F loop, and only required when different from the UM segment at the 2000E level. However, the values allowed at 2000E UM01 (AR, HS, IN, SC), are not the same as 2000F UM01 (HS, SC). Therefore, if the Patient event is identified as being an AR or a SC AND a service is being requested, then they must choose between HS or SC. Now, the UM01 code value of HS has a note stating:"Required if requesting a review of services related to an episode of care". The only purpose, based on the Loop note, to send the loop is for svcs related to the episode of care. Therefore, one would conclude the only value allowed is HS at the 2000F UM01. Why then is SC allowed at the 2000E level?

Submitter Assigned Keywords

278, UM01

Response

Various business needs define the scope of the episode of Care and Specialty Care differently. Inclusion of the HC and SC at both the 2000E and the 2000F loops, gives the flexibility to define complex Patient events. If the UM01 value in 2000F = SC, then the UM01 value in the 2000E loop must be SC. Additional clarification will be added to the next version of the guide.
Submission 5/26/2010
Status Date 7/30/2010
Status F - Final
Primary References
Document 005010X217
Section2.6
Page238
Set ID278
Loop2000F
Segment IDUM
Element Position01
Code ValueSC