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Back  RFI # 224: 4010A1 271 EB01 min required

Formal vs. Informal Help Informal Formal

Submitter

chuck wilhelm

Description

Section 1.3.7 and segment note 5 for 2110C EB segment and segment note 4 for 2110D EB segment indicate the minimum compliant response when the patient is found in the Information Source’s system. For the minimum compliant response, must an Information Source return a 2110C or 2110D EB segment with EB01 = “1” or “6” to indicate the patient who has been located in their system has Active or Inactive coverage or may they use any of the values “1” through “8” if those values are more appropriate?

Response

Based on the definition of the word “minimum” and generally understood usage, one meets a “minimum” requirement when more than the minimum is provided. In the case of information, when one communicates more than the minimum information, one has met the minimum requirement.

A “minimum” requirement establishes a stated paucity of information that must be sent. The implementation guide clearly encourages more than the minimum information to be sent. However, since Section 1.3.7 requires a communication of “Active” or “inactive” coverage, only codes 1 through 8 explicitly meet the minimum data requirement because only those codes have the specific statement of “active” or “inactive” in their code definition. Therefore, it is permissible to send other values in EB01 provided that a code value from those listed as values 1 through 8 appears in one instance of EB01 in Loop 2110C or Loop 2110D.
Submission 3/23/2005
Status Date 6/27/2005
Status F - Final
Primary References
Document 004010X092A1
Section1.3.7
Page20
Set ID271