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Back  RFI # 1422: Repeating EB03

Formal vs. Informal Help Informal Formal

Submitter

Amanda Sibley

Description

We return benefits for two different therapy capitation amounts, one tied to EB03 = 'AD' and another for EB03 = 'AF'. These two benefits have the same starting balance, so when we return the amount remaining, it is often that each of these are returned in two separate EB loops, but where everything else in 2110C is the same. This would not be the case if any of the therapy dollars had been utilized from either bucket.

As per the note on page 293 of the IG, starting with “EB03 is a repeating…:”, is the information source required to perform the necessary logic to determine if benefits are equal, and if so, combine them into one repeating EB/2110C level? But then when they are different dollar amounts divide them into two distinct EB loops?

Submitter Assigned Keywords

EB03 repeating data element

Response

Yes, to comply with the guide, if all values in the 2110 loop are the same except for the service type code, the repetition function must be used and both service type codes would be in EB03. If the dollar amounts are different, separate 2110 EB loops must be used.
Submission 9/29/2011
Status Date 1/5/2012
Status F - Final
Primary References
Document 005010X279
Section2.6
Page293
Set ID270271
Loop2110C
Segment IDEB
Element Position03
Industry NameService Type Code