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Back  RFI # 370: 276-Bill type REF Req'd on I?

Formal vs. Informal Help Informal Formal

Submitter

Ginger Wright

Description

In the 4010A1 the Institutional Bill Type REF segment is situational and is referred to in the front matter as a "supplemental identifier" however there is a grey note on the REF02 (which is required if the segment is present) that says "Required for institutional claims inquiries." This grey note has been removed in release 4050. Should this language in the REF02 grey note be interpreted to mean that this BLT REF segment is required when the claim that is the subject of the inquiry is an institutional claim? If yes what other data should be validated to determine that the status inquiry is for an institutional claim in order to require the presence of this segment? If no please provide standard/HIPAA IB basis we can provide to our trading partners for not having to make this a required segment.

Submitter Assigned Keywords

276, 2200D

Response

This issue is explicitly addressed in guide 004010X093. Usage of the Institutional Bill Type REF segment is determined by the note on the segment itself which reads "Only use this segment if the subscriber is the patient and bill type is being sent in the inquiry request in connection with an institutional bill." The note on REF02 applies only to that REF02 when the segment is used and does not impose any requirement on the segment that is not stated at the segment level itself. Since REF02 itself is Required, the note is in fact redundant. This situation is simlar to the requirement relationship between loops and segments within the Loops Usage section at the end of section 3.1 - Presentation Examples.
Submission 12/20/2005
Status Date 12/22/2005
Status F - Final
Primary References
Document 004010X093A1
Section3
Page81
Set ID276
Table2
Loop2200D
Segment Position100
Segment IDREF
Element Position02
Industry NameBill Type Identifier