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Back  RFI # 2267: Multiple EB03 Segments

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Submitter

Mark Harris

Description

The recommendation in RFI# 898 states the following:

''The relevant text in Section 1.4.7.1 for 271 item 8 states "The repetition function of EB03 must be used if only reporting the Active Status or if Patient Responsibility is the same across multiple benefits." The text DOES NOT state "The repetition function of the EB03 must ONLY be used if reporting ..."

X12N/TG2/WG1 will consider clarifying this language further in future TR3s to prevent confusion.''

I have seen rejections stating: 'Loop 2110C (Subscriber Eligibility or Benefit Information) is used. It should not be used when 1 iteration of loop 2110C is used with the same information except for EB03 value. Loop 2110C should be sent once with different EB03 values separated by repetition separator.'

Are these rejections correct? Is sending multiple EB Segments with the same information considered a compliance issue?

Response

As indicated RFI 898 and 1422, the repetition function of EB03 must be used when all data in the entire 2110 loop is the same except EB03 across multiple 2110 loops. The 2110 loops would be combined into one 2110 loop and each of the EB03 values would then be placed in the repeating portion of EB03.

It appears that the rejection you are referring to in your RFI is related to the submission of multiple EB’s where all of the EB segment values are the same except for the EB03. Such as the following.

EB*1*IND*1*GP~
EB*1*IND*2*GP~

It is correct that this usage of multiple EB segments is not compliant with the TR3 based on the following Segment note:

3. “EB03 is a repeating data element that may be repeated up to 99 times. If all of the information that will be used in the 2110C loop is the same with the exception of the Service Type Code used in EB03, it is more efficient to use the repetition function of EB03 to send each of the Service Type Codes needed. If an Information Source supports responses with multiple Service Type Codes, the repetition use of EB03 must be supported if all other elements in the 2110C loop are identical.”

The compliant way to send this data would be in a single EB segment.

EB*1*IND*1^2*GP~
Submission 1/29/2018
Status Date 3/23/2018
Status F - Final
Primary References
Document 005010X279
Section1.4.7.1