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Back  RFI # 2001: Duplicate Referral

Formal vs. Informal Help Informal Formal

Submitter

Jane White

Description

We are having a system/claim adjudication issue when multiple referrals are submitted by the requesting provider for the same services. We would like to add logic in the Referral submission to look for duplicate data and return the request as duplicate when certain criteria is met. I am looking for suggestions on what code to use in a AAA segment that would identify the Referral as a duplicate.

Response

In the 005010X217 Health Care Services Review implementation guide, a response for a duplicate submission can be completed with the use of the HCR segment. Report a value of "A3 - Not Certified" in HCR01 in combination with a value of "0Q - Duplicate Request" in HCR03, from the external code list, Health Care Decision Reason Codes. As a result the "AAA" segment should not be used.
Submission 1/8/2015
Status Date 3/16/2015
Status F - Final
Primary References
Document 005010X217
Section2000E
Loop2000E