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Back  RFI # 1461: 2010BA Addr rejects

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Submitter

bence gene

Description

Our 5010 validator rejects institutional claims when the 2010BA N3, N4 or DMG segments are present and there exists a 2000C loop with the corresponding segments for the patient. Several clients, who disagree with this, reference the 223 IG section 1.12.5 Claim and Line Redundant Information as justification that these rejections should be classified as warnings. Should the existence of a N3, N4 or DMG in the 2010BA loop when a 2000C loop is present cause the claim to reject?

Response

Section 2.2.1.1 governs how compliance with the TR3 is determined. In this case, when the patient is a dependent of the subscriber and cannot be uniquely identified using the subscriber’s identifier, loop 2000C is required. Also, the situational rules for the N3, N4, and DMG segments in loop 2010BA specify that these segments not be sent in this situation. Section 2.2.1.1 indicates that if a transaction contains a data element when the situational rule states "do not send", the transaction does not comply with the implementation guide. Therefore, a transaction containing the N3, N4, and DMG segments when the patient is a dependent of the subscriber and cannot be uniquely identified using the subscriber’s identifier is not compliant with the TR3.

Refer to RFI 1512, which clarifies the ASC X12 position on rejecting or accepting transactions that do not comply with the governing TR3.

Section 1.12.5 cannot override section 2.2.1.1 and therefore does not dictate the receiver's reaction when receiving a non-compliant transaction. That is up to the receiver based on its business process and any applicable regulations (ref. RFI 1512). We will reconsider the wording of 1.12 in a future version of this implementation guide.
Submission 12/2/2011
Status Date 2/9/2012
Status F - Final
Primary References
Document 005010X223
Section1.12.5
Page45
Set ID837I
Table2
Loop2010BA
Segment IDN3