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Back  RFI # 406: 271 Returning Other Payer

Formal vs. Informal Help Informal Formal

Submitter

Robert Huffman

Description

Is it appropriate for a payer to return a 271 which includes 2120 Loop using code PR in NM1 for Benefit Related Entity identifying other information sources when it cannot be determined whether those other payers are primary, secondary, or tertiary?

Submitter Assigned Keywords

Benefit Related Entity

Response

This issue is explicitly addressed in guide 004010X092. The 2120C loop SUBSCRIBER BENEFIT RELATED ENTITY NAME NM1 segment supports qualifiers in NM101 to identify Primary, secondary and tertiary payers as well as a generic Payer. Since the specific and generic qualifiers are supported, it is appropriate for a payer to identify in a 271 other payers that can not be determined to be primary, secondary or tertiary.
Submission 5/2/2006
Status Date 7/10/2006
Status F - Final
Primary References
Document 004010X092A1
Section3
Page250
Set ID271