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Back  RFI # 1432: HI Segment in 005010X215

Formal vs. Informal Help Informal Formal


Todd Cochrane


I have a request for clarification regarding the use of the HI (Patient Diagnosis) segment within the 005010X215 transaction. The Situational Rule states: Required when valued on the inquiry and used by the UMO to search for authorizations. This implies it is search criteria. However, if this field is intended to represent search criteria, which field should be used to repsent the diagnosis code assigned to the Authorization itself? If the 2000E/HI field is intended to represent the diagnosis code indicated on the Authorization, then it does not provide enough sesgments for the trading partner to return all diagnosis codes that were originally indicated.
The 278 request for authorization provides multiple diagnosis code fields, however in this transaction only one code is allowed. Pelase let me know if you have any guidance on this issue.

Submitter Assigned Keywords

278 authorization diagnosis code


When the HI is submitted on the inquiry request, it is used as search criteria and the associated response will contain all event history that matched that diagnosis code.

The HI on the response is intended to represent the diagnosis code that was submitted as search criteria on the 278 inquiry. We understand that limiting the HI repeat in the response to have 1 diagnosis code didn’t meet the industry need, therefore, this has been expanded in the next version to support 12 diagnosis codes.
Submission 10/11/2011
Status Date 11/21/2011
Status F - Final
Primary References
Document 005010X215
Set ID278