RFI Browser

Back  RFI # 397: REF Functional Equivalence

Formal vs. Informal Help Informal Formal

Submitter

Joe Schnug

Description

Our company's HIPAA, 4010A transaction certification web site has the HIPAA edit below in place for all HIPAA transaction sets:

Not allowing the same REF segment qualifier value (REF01) to be repeated within the a second iteration of a specific loop.

The certification web site directed us to the X12 4010 Standards guide, pages 72-73, section 6.3 Functional Equivalence. Within this section it is referenced that it can be circumvented by assigning different codes, but it does not state that like REF01s within a second iteration of a loop is a violation of semantics (p. 73).
I was unable to identify a specific HIR on the Portal. Please review and provide your interpretation. Should a HIPAA error be generated if REF01 is submitted with the same qualifier within the second loop iteration?
e.g.
NM1*DN*2
REF*G2*2330D OTHER PAYER REFERRING 01
NM1*P3*2
REF*G2*2330D OTHER PAYER REFERRING 03

Response

Two iterations of the 2330D loop are allowed by the 837 Professional Claim implementation guide, one for Referring Provider and one for Primary Care
Provider. Each iteration of the loop may contain other payer secondary ID's in a REF segment. It is valid to have the same type of identifying number in both iterations of the 2330D loop. That is, both can be a
Provider Commercial Number (REF01 = G2), a Medicaid Provider Number (REF01 = 1D), or any other valid qualifier value in REF01. In fact, in most cases
where two iterations of 2330D are submitted along with secondary ID's, the type of identifier for the secondary ID's will be the same in both loops.

Section 6.3, "Functionally Equivalent Data" Override, of the X12.59 IMPLEMENTATION OF EDI STRUCTURES — SEMANTIC IMPACT document does not
address the occurrence of multiple iterations of a segment within a loop. Rather, that section addresses like segments at different levels of parent/child structures within a transaction.
Submission 3/28/2006
Status Date 5/19/2006
Status F - Final
Primary References
Document 004010X098A1
SectionN/A
Page380
Set ID837P
Loop2330D
Segment Position355
Segment IDREF
Element Position01
Industry NameOther Payer Referring Provider Identific
Code ValueG2