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Back  RFI # 2258: 2320 SBR05 Requirement

Formal vs. Informal Help Informal Formal

Submitter

Jennifer Kimbrough

Description

The 2320 SBR05 Situational Rule on page 299 seems to indicate the Other Payer Insurance Type Code is required ANY time Medicare is listed as the Other, non-primary, Payer regardless of the Destination Payer listed in 2010BB.

RFI#1190, although not related to 837p, recommendation seems to indicate the opposite stating "The 837P and 837D 2000B SBR05 and 2320 SBR05 both REQUIRE an insurance type code when the DESTINATION PAYER in loop 2010BB IS MEDICARE and Medicare is not the Primary Payer. The only codes used in the 837P and 837D SBR05 are codes 12, 13, 14, 15, 16, 41, 42, 43 and 47.

Can you please clarify whether the requirement applies to ANY destination payer when Medicare is in Loop 2330B for the same iteration of Loop 2320 SBR01 not equal to P - as this is our interpretation of the Situational Rule being disputed by a customer.

Submitter Assigned Keywords

2320 SBR05 INSURANCE TYPE CODE

Response

The Situational Rule of the Loop 2320 SBR05 states, “Required when the payer identified in Loop ID-2330B for this iteration of Loop ID-2320 is Medicare and Medicare is not the primary payer (Loop ID-2320 SBR01 is not P). If not required by this implementation guide, do not send.” There is no requirement that the Loop 2010BB Destination Payer be restricted to Medicare. Therefore, the Loop 2010BB Payer may be any payer.
Submission 11/28/2017
Status Date 1/19/2018
Status F - Final
Primary References
Document 005010X222A1
Section2
Page299
Set ID837
Table2
Loop2320
Segment Position2900
Segment IDSBR
Element Position05
Industry NameInsurance Type Code
Secondary References
RFI ID 2740
Document 005010X279
Section2712110C
Page299
Set ID271
Table2