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Back  RFI # 1691: 271 plan max payment exclusion

Formal vs. Informal Help Informal Formal

Submitter

Eric Scott

Description

We have a plan level maximum payment limitation that applies to all covered service type codes except one. I can codify the limitation as follows:
EB*F*IND*30***23*1500.00*****Y~

How can I indicate, in a compliant manner, that this limitation does not apply to service type code 41?

Submitter Assigned Keywords

271 Limitation Plan Level Max

Response

Use EB01 = H (Unlimited) to indicate there is no cap on the benefit.

Using the example from the Description:

EB*F*IND*30***23*1500*****Y~
EB*H*IND*41***23******Y~
Submission 10/4/2012
Status Date 2/1/2013
Status F - Final
Primary References
Document 005010X279
Section1.4.12
Page289
Loop2110C
Segment Position1300
Segment IDEB