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Back  RFI # 1925: WC Ebills subscriber address

Formal vs. Informal Help Informal Formal

Submitter

Holly George

Description

The 5010 837P TR3 has a situational rule in the 2010BA N3 segment that states "Required when the patient is the subscriber or considered to be the subscriber. If not required by this implementation guide, do not send.".

In the case of Work Comp Ebills, we have insurance carriers asking for the employer's address. Since the employer is the subscriber, the address would be sent in the 2010BA N3 and N4 segment.

The patient address is sent in the 2010CA N3 and N4. This causes a problem with the X12 validation of the claim. When addresses are sent in both segments it causes a level 4 (type 4) validation error with situational testing.

How should this be handled in the case of a professional work comp Ebill? Can addresses be sent in both segments under these circumstances? Does X12 plan on making modifications to the TR3 to accommodate this situation?

Submitter Assigned Keywords

Professional Work Comp Ebill subscriber and patient addresses

Response

The patient address is reported at either the 2010BA or 2010CA loop. It is not compliant with the TR3 to report in both places, which is why the error is occurring between the two loops. The 2010BA rule is very clear that the address is to only be reported if the patient is the subscriber. The employer (who is always the subscriber in workers' compensation) is not the patient, therefore reporting the employer's address (or requiring it to be reported) in the 2010BA loop is not compliant with the TR3.
Submission 4/16/2014
Status Date 7/16/2014
Status F - Final
Primary References
Document 005010X222
Section3.2
Page124
Set ID837
Loop2010BA
Segment IDN3
Industry NameSubscirber Address