RFI Browser

Back  RFI # 1105: 837P Svc Referral Nbr Repeat

Formal vs. Informal Help Informal Formal

Submitter

Donald Graves

Description

On page 407 of the 5010X222 837P TR3, the Segment Repeat for the Service Level Loop 2400 Referral Number is 5. The TR3 Note states to use DE REF04 to indicate the payer id of non-destination payers. This suggests that the maximum number of Referral Numbers for a service I can report is 5, presumably one for the destination payer and one each for up to 4 non-destination payers. However, Loop 2320 has a repetition of up to 10, in which I can report up to 10 non-destination payers. Assuming that the service referral number for each non-destination payer is not the same as the referral number given at the claim level, how will I be able to report the Referral Numbers for the other 6 non-destination payers for which there are insufficient repeats of the Referral Number REF segment? (btw, same q for Prior Authorization.)

Submitter Assigned Keywords

Service level Referral number non-destination payers

Response

There is no way to report service specific referral or prior authorization numbers in a case where there are more than five payers on a claim with service specific numbers on a specific service. Even though there are 10 repeats of the Loop 2320 SBR segment, it is not practical that all 10 payers would enforce the Prior Authorization and/or Referral requirements. For the sake of practicality, only 5 repeats of the 2400 Referral and Prior Authorization segments were allowed.

Recommendation

If there is a business case for more repeats of the 2400 Referral and Prior Authorization segments this need should be brought to X12 for consideration in a future version of the transaction.
Submission 7/13/2010
Status Date 9/3/2010
Status F - Final
Primary References
Document 005010X222
Section2
Page407
Set ID837P
Table2
Loop2400
Segment Position4700
Segment IDREF
Industry NameReferral Number