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Back  RFI # 1562: Clarify Section 1.12.5

Formal vs. Informal Help Informal Formal

Submitter

Gayle Carswell

Description

Does the description of "redundant data" as described in this section of the 5010 IGs apply to duplicate data that could be submitted within a single segment? The example that was presented was when the HI segment for Value codes (BE) is included on a claim and within that segment the same Value Code/Value is listed twice. Here is the segment example (2 occurrences of Value code 81 with value 13).

HI*BE:09:::5491*BE:18:::7967.35*BE:19:::22966.01*BE:80:::19*BE:81:::13*BE: 81 :::13*BE:82:::19

The Plan used the following language from this section 1.12.5 to interpret this as acceptable and not non-compliant, even though an EDIFECS edit was received:

Other examples exist in the claim implementation guides where the business cases open up the possibility for redundant data to be reported. For all such situations, the principle is to “ignore, but don’t reject”.


EDIFECS edit: Value of subelement HI06-02 has been
already used. Value codes are expected to be unique within claim.

Submitter Assigned Keywords

redundant claim/line information

Response

No, it is the intent that each code be unique.

Each healthcare code should add information to the claim. Duplicate information would not be additional information, so it would not be consistent with the TR3 to send duplicate value codes in the HI segments. In the example given it is unclear if the sender is indicating 13 days or 26 days which could result in claims being incorrectly processed.

The intent of section 1.12.5 is to allow redundant data to be reported in different locations within the same transaction. In the example supplied, the data is reported twice in the same location so this section does not apply.
Submission 4/9/2012
Status Date 6/5/2012
Status F - Final
Primary References
Document 005010X223
Section1.12.5
Page45
Set ID837I
Loop2300
Segment Position2310
Segment IDHI
Element Position01
Component Position01
Industry NameValue Code
External Code List132
Code Value81
Secondary References
RFI ID 2020
Document 005010X223
Section1.12.5