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Back  RFI # 2069: Multiple REF*CE segments in 83

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Submitter

Jerry Sobotka

Description

The REF segment within the 2100 Loop of the 835 transaction provides for a number of opportunites for the Payer to provide additional information regarding the adjudication of the claim. Specific to this RFI, additional clarification is requested relative to the use of the CE value in the REF01. The Front Matter in the TR3 (1.10.2.15) aludes to the reporting of a single contract ("This transaction set provides a method for communicating to a provider which contract applies to a particular claim."), though the verbiage is not explicit. Payers may interpret that, given the Segment Repeat value of 5, the Payer may submit up to five REF segments, all with the REF01 value of CE. Should the Payer ever use the value of CE in multiple REF segments within the 2100 Loop?

Submitter Assigned Keywords

REF*CE

Response

The 005010X221A TR3 does not explicitly prohibit repeating a qualifier for segments within the same loop.

Recommendation

If using the same qualifier multiple times to present different data, creators of the transaction data must recognize that receivers may not know which repetition of the data to use and/or that data may actually be overlaid as subsequent repetitions of the qualifier are processed. It is strongly recommended that submitters not use the same qualifier multiple times for segments in the same loop.

In version 006020 and future 835 TR3 versions, the Class of Contract Code was moved to a separate REF segment iteration with a repeat of 1, and front matter added to the TR3 to expand on the usage of this distinct segment.
Submission 6/26/2015
Status Date 8/27/2015
Status F - Final
Primary References
Document 005010X221
Section2.4