RFI Browser

Back  RFI # 1734: Order Finan Resp in 271

Formal vs. Informal Help Informal Formal

Submitter

Marcia Henderson

Description

As a health plan we have products that the order of the financial responsibility differs. We may have a co-pay per visit and also subject to deductible/coinsurance or the policy may have them meet deductible then pay a co-pay per visit. is the order of the EB segments intended to explain the order the financial responsibility is to be taken or is a MSG segment explaining order, as we are doing today, the appropriate method?

Submitter Assigned Keywords

Financial Responsibility 271

Response

The order of EB segments (or any like level segments or loops) does not carry any explicit or implied relationship. It may be possible to use other elements and segments in the 2110 loop (such as the HSD segment) to indicate which financial responsibility applies first.

For example, if the first two visits require a copayment, you can use EB07 and the HSD to identify the benefit.

EB*B**BY***27*10~
HSD***VS**31*2~

Then if the Deductible then kicks in after the first two visits, you can also use EB07 and the HSD to identify the benefit.

EB*C**BY****100~
HSD***VS**30*2~

If use of the elements and segments in the 2110 loop (such as the HSD segment) cannot sufficiently indicate which financial responsibility applies first, use of the MSG would be appropriate.

Section 1.4.12 Message Segments of the 005010X279A1 TR3 as modified by the errata explicitly 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). Information that has been provided in codified form in other segments or elements elsewhere in the 271 for the individual must not be repeated in the MSG segment. If the information cannot be codified, then cautionary use of the MSG segment is allowed as a short term solution. It is highly recommended that the entity needing to use the MSG segment approach X12N with data maintenance to solve the long term business need, so the use of the MSG segment can be avoided for that issue.

Please submit a complete change request with business requirements to ASC X12.
Submission 1/18/2013
Status Date 2/27/2013
Status F - Final
Primary References
Document 005010X279
Section2.4
Page289
Loop2110C