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Back  RFI # 1972: 278 HCR03 = 90 in PWK

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Submitter

Deb McCachern

Description

The 278 X217 TR3, in the TR3 Note 1 of the 2000E and 2000F PWK segments in the response, makes reference to HRC03 of 90, as such: “If the UMO has pended the decision on this health care services review request (HCR01 = A4) because additional medical necessity information is required (HCR03 = 90), the UMO uses this segment to identify the type of documentation needed such as forms that the provider must complete. The UMO can also indicate what medium it has used to send these forms.”

There is no longer an HCR03 of 90 in the externalized Decision Reason Code list. Code '0P' has the same description as the former HCR03 of 90.

Please explain how to resolve this discrepency. Thank you.

Response

Code value 'OP' should be used in HCR03 to replace documented code value '90' in this case. The guide will be updated to reflect this change in the next version.
Submission 9/24/2014
Status Date 1/20/2015
Status F - Final
Primary References
Document 005010X217
Section2
Loop2100
Segment IDPWK
External Code List886
Code Value0P