RFI Browser

Back  RFI # 2047: Dental Vendor's 271 response

Formal vs. Informal Help Informal Formal

Submitter

Tucker David

Description

We are currently reviewing our Dental Vendor's 271 responses to make sure they are currently meeting the Admin Simplification requirements.

During our review we found that the Dental Vendor is sending back Service Types in two formats. One format showing the patient responsiblity and another line showing the Provider's using EB01=D.

EB*A*IND*24*****.2****Y
EB*D*IND*24*****.8****Y

When we questioned them on this, they stated that there was nothing in the TR3 that stated they could not do this.

We would like clarification if what our Dental Vendor is sending back on their 271s (using EB01=D for Provider share) is valid per the TR3.

Submitter Assigned Keywords

Dental 271 EB01=D

Response

It is correct that nothing in the TR3 prevents the EB*D*IND*24*****.8****Y usage as described in your request for interpretation.

Recommendation


The D – Benefit Information Benefit Code is not self-explanatory. If not described by another means outside the TR3, the MSG segment can be used to provide this information in a manner such as this:

MSG*D Benefit Information EB segment is the percentage of Provider responsibility~
Submission 5/8/2015
Status Date 6/9/2015
Status F - Final
Primary References
Document 005010X279
Section1.4.9