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Back  RFI # 2012: B.1.1.3.1.2 Ambulance Mileage

Formal vs. Informal Help Informal Formal

Submitter

Betty Westbrook

Description

Please clarify in Section “B.1.1.3.1.2 Decimal” the sentence “Trailing zeros following the decimal point must be suppressed unless necessary to indicate precision.” Can you please define what “unless necessary to indicate precision” would mean? We would interpret this to mean that appending a “.0” indicates no more precision than reporting the whole number, and thus, the .0 should be removed (6.0 indicates no further precision than 6 does). Example, a payer requires ambulance mileage to be billed out to the nearest tenth of a mile. There is an edit requiring a decimal point be present with a digit following it. For payment purposes, this tenth value is used to round up to the next whole number to calculate reimbursement. Any value with a “.0” would remain as that whole number value, thus including it is not indicating further precision for rounding purposes. Can the “.0” be required? Prior related RFI 1526.

Submitter Assigned Keywords

B.1.1.3.1.2

Response

As stated in RFI 1858 Ambulance mileage is reported in the 005010X222 (837P) loop ID 2300 data element CR106.This data element places no precision constraints beyond the data type R and data size 1/15 for mileage being sent in a claim. ASC X12 data type R, as specified in 837P § B.1.1.3.1.2 Decimal, permits use of values with tenths, hundredths, etc. Thus, any precision in any sent mileage value is compliant with the TR3.

As stated in RFI 1526 the requirement to report to a specific level of precision can be established by the information receiver in order to support particular business rules. These requirements are to be documented by the information receiver in the trading partner agreement and/or companion guide.

It should be noted that by including the trailing zero, the sender is narrowing the range for the actual value. Using the example provided, reporting a value of 6.0 miles indicates that the actual mileage was within a tenth of a mile whereas a reported value of 6 miles has a tolerance of one mile.

Recommendation

Review trading partner agreement and payer companion guide for guidance on reporting mileage on ambulance claims.
Submission 2/18/2015
Status Date 4/6/2015
Status F - Final
Primary References
Document 005010X223A2
SectionB.1.1.3