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Back  RFI # 1519: Claims for both Sub and Dep

Formal vs. Informal Help Informal Formal


Jennifer Delmont


When a provider is sending claims for both the subscriber and the patient do they have to repeat the 2000B level before the 2000C? We have an example where the provider is sending 1 2000B (HL*140*1*22*1~SBR*P*18*99999******12~) with a claim for the subscriber. Then they are submitted a claim for the dependent (HL*141*140*23*0~PAT*01~) without repeating the 2000B HL and SBR so our edits are rejecting the second claim because 2000C is present when SBR02 = 18. Should the provider repeat 2000B or should they remove the value of SBR02?

Thank you in advance for your guidance


This is explicitly addressed in section of the TR3 in the Subscriber #4 HL example, and in the following note in the 2000B HL04 element note that reads:

“In order to send claims for the subscriber and one or more dependents, the Subscriber HL, with Relationship Code SBR02=18 (Self), would be followed by the Subscriber's Loop ID-2300 for the Subscriber's claims. Then the Subscriber HL would be repeated, followed by one or more Patient HL loops for the dependents, with the proper Relationship Code in PAT01, each followed by their respective Loop ID-2300 for each dependent's claims. “
Submission 2/8/2012
Status Date 4/18/2012
Status F - Final
Primary References
Document 005010X222