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Formal vs. Informal Help Informal Formal

Submitter

les orr

Description

Page 23 of the Institutional 5010 TR3 shows an example of a COB claim, payer A, B, C. The sequence of the payers in the example are A B C, for loops 2320, 2330B, and 2430 are all the same sequence. Does this imply that the sequence of payers in loops 2320, 2330B and 2430 must be consistent? Or is it acceptable for 2320 to be ABC, 2330B to be BCA and 2430 CBA?

Submitter Assigned Keywords

payer sequence

Response

The 2330B loop is a nested loop inside the 2320 loop, any specific 2330B loop must relate directly to the 2320 loop within which it exists. That is, the payer identified in the 2330B must be the payer for the subscriber identified in 2320. The primary payer 2330B loop must be present within the 2320 primary loop. The secondary payer 2330B loop must be present within the 2320 secondary payer loop. The tertiary payer 2330B loop must be present within the tertiary 2320 loop.

The sequence of the 2430 loops does not have to follow the sequence of the 2320 loops because in the 2430 the SVD01 other payer identifier links the 2430 loop to the proper 2320. Therefore, the service payment information for the first service line can be reported tertiary, then secondary then primary. The second service line could contain 2430 loops ordered secondary, then tertiary, then primary.

For more information see section 1.4.3.1 Loop Labeling, Sequence, and Use.
Submission 4/12/2012
Status Date 6/5/2012
Status F - Final
Primary References
Document 005010X223
Section1.4.1.4
Page23