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Back  RFI # 2193: 271 ER Facility/Provider Chrgs

Formal vs. Informal Help Informal Formal

Submitter

Jenn Alexinas

Description

If Emergency Services benefits differ for ER Facility charges and ER Physician charges, can two EB01 loop segments be sent for Service Type Code 86 (Emergency Services) and a message be used after each to clarify that one is for Provider and the other is for Facility charges?

Submitter Assigned Keywords

271 Transaction Emergency Services Facility Charges Physician Charges

Response

Yes, it is both compliant with the TR3 and appropriate to send two 2110C or 2110D loops with EB03 equal to Service Type 86 when there is a need to provide differing benefit details and other EB03 Service Type codes cannot provide that distinction.

The MSG segment may also be used when the eligibility or benefit information cannot be codified in existing data elements (including combinations of multiple data elements and segments); AND when this information is pertinent to the eligibility or benefit response.

Recommendation

The MSG segment can be used when a current version of the TR3 does not support a codified usage. If you have a business need not supported in a published TR3, you may submit an ASC X12 change request for consideration in a future version of the TR3. Change requests are submitted at http://changerequest.x12.org/
Submission 1/30/2017
Status Date 3/18/2017
Status F - Final
Primary References
Document 005010X279
Section2.6
Loop2110C
Segment IDEB0