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Back  RFI # 2005: 835 Use of PER-IC & REF-OK

Formal vs. Informal Help Informal Formal

Submitter

Sonya May

Description

Is it compliant with the TR3 if a payer sends the 1000A/PER*IC segment to identify its website, but does not publish online health policies nor use the 2110/REF*0K segment?

Submitter Assigned Keywords

PER IC REF 0K Healthcare Policy Website

Response

In the 005010X221A1 TR3, the situational rule for the 1000A PER*IC segment explicitly states “Required when any 2110 loop Healthcare Policy REF Segment is used. If not required by this implementation guide, do not send.” Then one of the situational rules for the 2110 REF*0K explicitly states “The payer has a published enumerated healthcare policy code list available to healthcare providers via an un-secure public website and …”

So the payer cannot send a 1000A PER*IC if they don’t send a 2110 REF*0K, and they would not meet the requirements for sending the 2110 REF*0K if they don’t publish online health policies.
Submission 1/23/2015
Status Date 3/23/2015
Status F - Final
Primary References
Document 005010X221
Section2.4 p209
Page100