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Back  RFI # 1352: 5010 837 - HI Segments

Formal vs. Informal Help Informal Formal

Submitter

Ron Birkemeyer

Description

HI segments in 837 transactions where more than one composite is used within the segment all have statements similar to the following in the second and subsequent composite iterations -- "Required when it is necessary to report an additional [procedure] and the preceding HI data elements have been used to report other [procedures]. If not required by this implementation guide, do not send."

The verbiage infers that there should be no gaps in the composite iterations, e.g., they should be used in sequence; and as well, seems to infer that duplicate [procedures] may not be reported.

Please advise if it was the intent of the claims work group that both of these criteria should apply. Thank you.

Submitter Assigned Keywords

5010 837 HI Gap Duplicate

Response

Additional composites within the HI segment must be used in sequential order. Duplicate information would not be "additional" information, so it would not be consistent with the TR3 to send duplicate Procedure or Diagnosis codes in the HI Segments. 
Submission 6/30/2011
Status Date 8/26/2011
Status F - Final
Primary References
Document 005010X222
Section837 Impl
Page226
Set ID837
Table2
Loop2300
Segment Position2310
Segment IDHI
Secondary References
RFI ID 1794
Document 005010X223
Section837 Impl
Page184
Set ID837I
Table2
Loop2300
Segment Position2310
Segment IDHI
Industry NameVarious