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Back  RFI # 2188: Useage of 5010 837P 2000B SBR

Formal vs. Informal Help Informal Formal

Submitter

Coy Ungemach

Description

Hello,

This request is in reference to the TR3 for the HIPAA 5010 837 Professional Guide usage of the Loop 2000B SBR 03 and SBR 04 segments respectively.

Our interpretation of the use of these elements is as follows and we are seeking clarification and support of, if appropriate, our interpretation.

In the event that Loop 2000B SBR03 is valued, Loop 2000B SBR04 must not be valued. Referring to the SBR04 "Required when SBR03 is not used and the group name is available. If not required by this implementation guide, do not send."

Conversely, in the event that Loop 2000B SBR03 is not valued, Loop 2000B SBR04 may be valued.

Valuing both Loop 2000B SBR03 and Loop 2000B SBR04 would not be an allowable action.

Thanks in advance for your time and interpretation.

Response

Yes, submitting both the 2000B SBR03 and SBR04 on the same claim is not compliant with the guide.

The rule for the SBR04 reads “Required when SBR03 is not used and the group name is available” If the SBR03 is populated then the SBR04 must not be sent.






Recommendation

Review RFI 1512 for information regarding processing non-complaint transactions.
Submission 1/12/2017
Status Date 6/16/2017
Status F - Final
Primary References
Document 005010X222A1
Section2.4
Page116
Loop2000B
Segment Position0050
Segment IDSBR
Element Position04
Industry NameSubscriber Group Name