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Back  RFI # 1594: EB01=F (limitation) and HSD

Formal vs. Informal Help Informal Formal

Submitter

Tucker David

Description

Will you please clarify if the EB01=F (limitation) line is built correct and meets HIPAA requirements for using the HSD segments.

The example below is for our Home Health Care Benefit.

The Home Health Care has a 10% co-insurance patient liability as welll as 120 visits per 12 month period.

Will you please verify which of the below coding examples meet the X12 requirements for using the HSD values.


Example 1

EB*A**42*****.1****W~

EB*F**42*********W~
HSD*VS*120***34*12~


Example 2

EB*A**42*****.1****W~

EB*F**42******VS*120**W~
HSD*****34*12~

Submitter Assigned Keywords

EB01=F (limitation) and HSD segments

Response

Both examples are compliant with the requirements of 005010X279/005010X0279A1. The first example is the preferred method of the two as it keeps the delivery pattern contained in the HSD segment.
Submission 5/17/2012
Status Date 6/25/2012
Status F - Final
Primary References
Document 005010X279
Section2.6