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Back  RFI # 1302: 278X217 Service Level

Formal vs. Informal Help Informal Formal

Submitter

Minnie White

Description

Requesting clarification of the two sections below.
The second sentence in Section 1.11.5 seems to imply that the Service Level (Loop 2000F) is required when the request is for a Health Service Review. This seems in conflict with the first sentence in Section 1.12.4.
Section 1.11.5 Transaction Responses - The UMO must respond to each 278 transaction set received. If the UMO can process the service review request, the UMO must return a 278 response that contains an HCR segment at the Service Level (Loop 2000F) in the response to indicate the status of the service review.
Section 1.12.4 Services
The Service level (Loop 2000F) is not required on the 278 request. The requester
should value this loop only if the health care services review includes specific
services or procedures for which authorization is required. If the 278 request
does not include this loop, it must specify all the information pertaining to the category
of services requested at the Patient Event level (Loop 2000E).

Submitter Assigned Keywords

278X217 Service Level

Response

The 278 X217 had an error in the original guide. An errata X217E1 was generated to correct this issue. The 1.11.5 now states: "If the UMO can process the service review request, the UMO must return a 278 response that contains an HCR segment at the Patient Event Level (Loop 2000E) in the response to indicate the status of the service review."
Submission 4/21/2011
Status Date 6/16/2011
Status F - Final
Primary References
Document 005010X217
Section1.11.5
Page26
Set IDNA