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Back  RFI # 1673: 271 Service Type Code

Formal vs. Informal Help Informal Formal

Submitter

Eric Scott

Description

We have multiple benefit categories that correspond to STC 40. The categories are not easily expressed as a procedure code range, and they are not tied to provider specialty or facility.

We are required to respond to a STC 40 specific inquiry and to include STC 40 in a response to a generic inquiry.

I can include all covered procedure codes in the response, but this seems cumbersome.

I have also considered using a MSG segment to identify the sub types:
EB*D**40*****0.2~
MSG*SIMPLE EXTRACTIONS~
EB*D**40*****0.5~
MSG*OTHER ORAL SURGERY~

Is this an acceptable use of the MSG segment?

Submitter Assigned Keywords

Service Type Benefit Category 271

Response

This is not an acceptable use of the MSG segment. Additionally, there is no requirement in 005010X279A1 to support an explicit request containing Service Type Code (STC) 40 “Oral Surgery”. There are no requirements in 005010X279A1 to return anything other than STC 40 should you choose to support an explicit request containing STC 40. There are no requirements in the 005010X279A1 to return an STC 40 (Oral Surgery) in response to a generic inquiry (EQ01 = 30). The only dental code required to be returned if it is a covered benefit is 35 “Dental Care”.

Use of the MSG segment in this context would not be compliant with Section 1.4.12 of 005010X279A1 which states “Under no circumstances can an information source use the MSG segment to relay information that can be sent using codified information in existing data elements (including combinations of multiple data elements and segments).” If the information you are trying to convey can be represented by Procedure Codes, you may use multiple 2110 EB segments utilizing EB13 (either single codes in EB13-2 or by using the procedure range function of EB13-2 and EB13-8) to identify all of those procedures.
Submission 9/10/2012
Status Date 11/13/2012
Status F - Final
Primary References
Document 005010X279
Section1.4.12
Loop2110C
Segment IDEB
Element Position03