RFI Browser

Back  RFI # 1683: Subscriber Eligibility Loop

Formal vs. Informal Help Informal Formal

Submitter

SAM HERBERT

Description

As per the RFI # 665, the NM1 segment is required in the 2120 loop starting with the LS Segment (Subscriber Benefit Related Entity Name loop). As per the RFI # 1628, we are using the PRV segment to populate the Provider Taxonomy Code.

But there is a situational rule in the 2120C NM1 segment as "Required when provider was identified in 2100C PRV02 and PRV03 by Identification Number (not Taxonomy Code) in the 270 Inquiry and was used in the determination of the eligibility or benefit response."

Question: If we use the LS, NM1, PRV segment then it violates situational rule given in the NM1 segment. Please let us know on how this can resolved satisfying the requirements from the 2120C NM1, RFI # 665 and RFI # 1628.

Submitter Assigned Keywords

Subscriber Eligibility or Benefit Additional Information

Response

Use of the LS, NM1, PRV segment in the 2120C loop does not violate the second condition of the NM1 situational rule which states “required when needed to identify an entity associated with the eligibility or benefits being identified in the 2110C loop such as a provider (e.g. primary care provider), an individual, an organization, another payer, or another information source. If not required by this implementation guide, do not send.”
Submission 9/13/2012
Status Date 11/13/2012
Status F - Final
Primary References
Document 005010X279
Section1.1
Page329
Set ID271
Loop2120C
Segment PositionNM109
Industry NameBenefit Related Entity Identifier