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Back  RFI # 1666: 275 payer request

Formal vs. Informal Help Informal Formal

Submitter

Julia Dunicheva

Description

This question is for 275 - 005010X211.
Does this implementation support the following case:
1. Provider sends pre-authorization request to Payer (278, 005010X217)
2. Payer responds with the request for additional information with 278 (005010X217) and 275 (005010X211)
If such use of 275 is supported, when should be the value of BGN01?
If it's not supported, what other 275 TR3 supports it?

Submitter Assigned Keywords

BGN01 Pre-authorization

Response

No, this business scenario is not supported using the 275 (0050101X211) but will be supported in Additional Information to Support a Healthcare Services Review 006020X278 since BGN01 equal to 02 is not limited to the request only in that version.

Recommendation

We recommend using version 006020X278 when it is published.
Submission 8/17/2012
Status Date 9/27/2012
Status F - Final
Primary References
Document 005010X211
Section2.4
Page45
Set ID275
Segment IDBGN
Element Position01