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Back  RFI # 2024: Multiple Functional Groups 270

Formal vs. Informal Help Informal Formal

Submitter

Albetski Allan

Description

The TR3 005010X279 guide states that "It is required that the 270 transaction contain only one patient request when using the transaction in a real time mode...One patient is defined as either, one subscriber loop if the member is the patient, or one dependent loop if the dependent is the patient"

Does this statement disallow multiple functional groups from being sent within the same interchange? Can I have this structure and still be compliant:
ISA
GS ST/SE GE
GS ST/SE GE
IEA

Each ST/SE would have only one patient request.

Submitter Assigned Keywords

Realtime 270 Eligibility Multiple GS Functional Groups

Response

In addition to the quote stated, section 1.4.3 states "In a real time mode, the sender sends a request transaction to the receiver, ... , and remains connected while the receiver processes the transaction and returns a response...". That section also states "Although it is not recommended, if the number of patients is to be greater than one for real time mode ..., the trading partners (the Information Source, the Information Receiver and the clearinghouse the transaction is routed through, if there is one involved) must agree to exceed the number of recommended patient requests and agree to a reasonable limit." This same concept is also included in section 1.3.2.

As a result, since the structure in the question includes multiple transactions, as opposed to "a request transaction", it is not compliant with the guide's real time mode instructions. Multiple patients could be included in a single transaction in real time mode if all trading partners agreed and established a reasonable upper limit.

This response does not address CAQH CORE Operating Rule requirements which are external to the TR3.
Submission 3/4/2015
Status Date 4/2/2015
Status F - Final
Primary References
Document 005010X279
Section1.4.3
Page9