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Back  RFI # 407: Origin and Destination

Formal vs. Informal Help Informal Formal

Submitter

Whyte Linda

Description

The issue below was sent to me by a Medicaid payor. Is this true and where can I find this documented?

The X12 solution proposed handling ambulance transport origin and destination data for version 4010A1 as follows:
Origination: use loop 2310D, which is consistent with program memorandum AB-00-88 (page 10) which specifies where the pickup zip code should be.

If multiple service lines have different procedure modifiers, such as when indicating a multiple leg trip, then the origin location will be in the 2420C loop of the service line used for the previous leg of the trip (i.e. the destination of leg #1 is also the origin of leg #2).

Destination: use loop 2420C. The location specified in each occurrence of this loop indicates the destination consistent with the procedure modifier in SV101-3.

Submitter Assigned Keywords

Ambulance Origin and Destination proposed loops

Response

Submission of origin and destination of ambulance trips is not addressed in the currently mandated claims guide (004010A1). Research with ambulance billers and health plans found a number of workarounds have been successfully implemented, or proposed for future implementation. However, the constraints of the 4010A1 guide do not allow a workaround that effectively satisfies the needs of all. Each workaround that is in-place or proposed has problems if applied beyond the trading partners who developed that solution. Therefore, the Claims Workgroup will not develop a workaround or sanction an existing workaround for this information. The next version of the claim guide (005010) does provide a standard way for these locations to be reported.
Submission 5/4/2006
Status Date 11/6/2006
Status F - Final
Primary References
Document 004010X098A1
Section3.1
Page303
Set ID837p
Secondary References
RFI ID 364
Document 004010X098A1
Section3.1
Page514
Set ID837p