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Back  RFI # 144: Subscriber and Patient Looping

Formal vs. Informal Help Informal Formal

Submitter

Lisa English

Description

I have a subscriber, a claim for the Subscriber and a claim for a dependent in the same 837 file, I send
- Subscriber 2000B loop -HL04 is 1 (dependents)
- SBR record -SBR02 is 18 (self)
- Subscriber 2300 claim loop
- Patient 2000C loop -PAT01 is 19 (child)
- Patient 2300 claim loop

IG p104 (combined) states that claims should be handled this way.

However, I get a ClarEdi edit on this.

Must I send a second Subscriber loop? It negates the benefit of having nested Sbs/Pat looping.

Submitter Assigned Keywords

Subscriber Patient Looping

Response

IG 004010X098 does not specifically prohibit or require the structure of subscriber/claim/dependent/claim. Either structure is within the requirements of the guide.

Recommendation

The subsequent generation IG for the 837P does not permit that structure and requires subscriber/claim/subscriber/dependent/claim for the situation described. We recommend that providers implement that structure under the X098A1 guide.
Submission 11/12/2004
Status Date 1/6/2005
Status F - Final
Primary References
Document 004010X098
Section3.1
Page109
Set ID837P
Table2
Loop2000
Segment Position001
Segment IDHL
Element Position04
Industry NameHierarchical Child Code