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Back  RFI # 210: X093A1 2200D/E TRN, REF = LU

Formal vs. Informal Help Informal Formal

Submitter

Ginger Wright

Description

This Group Number REF segment was only added to Loop-ID 2200D in the Addenda. The TRN Note 3 in both 2200D and E was also changed from just 2200 to referencing the 2200D/E IG loop ids. It also made the 2200D TRN Situational. This effectively makes the 2200D Loop only allowed when the Subscriber is the Patient (Notes 1 and 3 of the 2200D TRN are contradictory. Note 1 says don’t use this TRN if Subs is not Patient instead use TRN in 2200E, but then 3 says if 2200D is present then TRN must be present). So there appears to be no way to send this Group No REF data when the Dependent is the patient. We have a payer who needs this Group No value to identify the claim and we cannot send both the 2200D and 2200E loops when the patient is the dependent. Please clarify the intent of these A1 changes to the TRN and rationale as to why the REF=LU was not included in the 2200E if the intent was for 2200D and E to be mutually exclusive. Thanks.

Submitter Assigned Keywords

X093A1 2200D 2200E TRN, REF LU 276

Response

The 004010X093A1 Implementation Guide does not support sending the Group Number REF when the dependent is the patient. The Group Number REF can only be sent when the patient is the subscriber, based on the 2200D TRN segment notes, the Loop 2200D defined usage and lack of the Group Number REF in Loop 2200E. Not adding the Group Number REF to the 2200E Loop was a misfortunate over-site that has been corrected in subsequent versions of the transaction.

TRN Notes 1 and 3 do not present a conflict. TRN Note 1 identifies the Situational usage for Loop 2200D, which starts with the TRN Segment. The intent of TRN Note 3 is to indicate the TRN Segment must be used if it is determined that the 2200D Loop is to be used, as a result of the condition in Note 1.

Recommendation

The WG cannot provide a workaround recommendation, because whatever we suggest is outside the 004010X093A1 guide structure.
Submission 3/2/2005
Status Date 4/12/2005
Status F - Final
Primary References
Document X04010X093A1
Section1
Page8
Set ID276
Table2
Loop2200D
Segment Position090
Segment IDTRN