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Back  RFI # 1395: EB11 and 2120 NM1 SR

Formal vs. Informal Help Informal Formal

Submitter

Cindy Monarch

Description

A single service type (2110C/D EB03) can be reported multiple times throughout a 271 to report applicable patient liabilities & benefit limitations. When 2110C/D EB11 equals “Y” or “U”, and there is a Certification Management Organization (CMO) responsible for pre-cert/pre-auth of services, must we report the CMO in each 2110C/D occurrence (Example A) or is it acceptable to report the CMO entity only once per service type (Example B)? We are asking this to obtain clarification on the 2120C NM1 situational rule.

Example A
EB*A**4**27**.1***Y*W~
LS*2120~
NM1*X3*2*RADIOLOGY REVIEW ORG~
PER*IC*CONTACT NAME*TE*8001234567~
LE*2120~
EB*F**4***22***QA*1*Y*W~
LS*2120~
NM1*X3*2*RADIOLOGY REVIEW ORG~
PER*IC*CONTACT NAME*TE*8001234567~
LE*2120~
EB*A**5***27**.1****W~

Example B
EB*A**4***27**.1***Y*W~
LS*2120~
NM1*X3*2*RADIOLOGY REVIEW ORG~
PER*IC*CONTACT NAME*TE*8001234567~
LE*2120~
EB*F**4***22***QA*1*Y*W~
EB*A**5***27**.1****W~

Submitter Assigned Keywords

EB11 2120C/D NM1

Response

5010 does not require the 2120 loop be sent to identify the CMO if EB11 = Y or U. You may send this information at your discretion and as few or as many times as you desire as noted in the second portion of the 2120C NM1 Situational Rule which states “Required when needed to identify an entity associated with the eligibility or benefits being identified in the 2110C loop”. “Required when needed” is to be determined by the creator of the transaction.
Submission 9/6/2011
Status Date 1/4/2012
Status F - Final
Primary References
Document 005010X279
Section2.6
Set ID271
Loop2110