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Back  RFI # 2198: Loop 2000C PAT01 Valid Values

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Submitter

Jennifer Burger

Description

A payer is requiring a value of "11" to represent organ donor in Loop 2000C, PAT01 (patient relationship to insured) for inpatient transplant claims. This is not a valid value per the 5010 ANSI TR3 guide.

Please advise if the payer's requirement is non-compliant with ANSI standards to require providers to enter a value that is not provided in the code list in the TR3. The correct value for organ donor is 39, and therefore is the value the payer should be requiring/accepting.

Submitter Assigned Keywords

Loop 2000C, PAT01, Patient Relationship to Insured

Response

It is not compliant with the 5010 837I TR3 to submit a value of 11 in the loop 2000C PAT01. The correct value for organ donor is 39.
Submission 2/15/2017
Status Date 4/3/2017
Status F - Final
Primary References
Document 005010X223
Section2.4
Page133
Loop2000C
Segment Position1069
Segment IDPAT
Element Position01
Industry NameIndividual Relationship Code
Code Value11