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Back  RFI # 1255: 5010X217 278 Rqst 2000E CR607

Formal vs. Informal Help Informal Formal

Submitter

Thomas Pothen

Description

For the field 2000E-CR607 (Medicare Coverage Indicator) has the following semantic
"SEMANTIC: CR607 indicates if the patient is covered by Medicare. A ā€œYā€ value
indicates the patient is covered by Medicare; an ā€œNā€ value indicates patient is not
covered by Medicare."

It is shown as a REQUIRED field, and the only valid value shown is
W = Not Applicable.

Please resolve the conflict between these two statements.

Submitter Assigned Keywords

5010X217 278 Request 2000E CR607

Response

There is no conflict. Since CR607 is mandatory in the ASC X12 standard, it must be populated. The semantic note identifies the meaning of values "Y" and "N" but states nothing about the value "W", which is a valid code for this data element within the ASC X12 standard. Medicare coverage is not applicable within the scope of the Health Care Services Review Information - Review related to home health care, private duty nursing, or services by a nurse's agency. Therefore, code "W" is required to be sent to meet the standard requirement to populate this element.
Submission 3/2/2011
Status Date 5/12/2011
Status F - Final
Primary References
Document 005010X217
Section2
Page199
Set ID1073
Loop2000E
Segment IDCR6
Element Position07
Industry NameYes/No Condition or Response