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Back  RFI # 1674: 271 Multiple networks

Formal vs. Informal Help Informal Formal

Submitter

Eric Scott

Description

How can I properly codify a plan with multiple networks and different benefits within each network? For example, a plan with Provider Network A and Provider Network B. Can I use EB05 to identify the network? Should I use a MSG segment?

EB*A**38**PROVIDER NETWORK A***0.2****Y~
EB*A**38**PROVIDER NETWORK B***0.3****Y~
EB*A**38*****0.5****N~

Or

EB*A**38*****0.2****Y~
MSG*PROVIDER NETWORK A~
EB*A**38*****0.3****Y~
MSG*PROVIDER NETWORK B~
EB*A**38*****0.5****N~

Is there a different way to identify the network that is associated with the benefit?

Submitter Assigned Keywords

271 Provider Networks

Response

Use of EB05 would not be compliant with the requirements of 005010X279A1 to identify a provider network as this element is only to be used for a Plan Name, not to identify a Provider Network. The note on EB05 states “This element is to be used only to convey the specific product name or special program name for an insurance plan.”

Use of a 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).”

This information can be codified using 2110C/D REF segment with REF01 = N6 (Plan Network Identification Number). When REF01= N6, the situational rule requires the use of REF03 (which in this case would be the Network Name). REF02 would contain the plan network identifier.
Submission 9/10/2012
Status Date 11/13/2012
Status F - Final
Primary References
Document 005010X279
Section1.4.12
Loop2110C
Segment IDEB
Element Position12