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Back  RFI # 410: subscriber dependent loop

Formal vs. Informal Help Informal Formal

Submitter

Monica Eure

Description

In the 270/271 it states: Sub (2000C loop) The sub is a person who can be uniquely identified to an information source, traditionally referred to as a member. The subscriber may or may not be the patient. Depend (2000D loop) The dependent is a person who cannot be uniquely identified to an information source, but can be identified by an information source when associated with a subscriber. But in the 276/277 it does not define Sub and Depend. loop usage as clearly: If the 276 IG, on page 100, for the NM109, the note states: At this level, NM108 and NM109 are required if the dependent is assigned a unique identification number that is separate from the subscriber number in HL04. The guide gives you a place to put a unique ID for the dependent. In the 2000D Sub Level Loop and the 2100D Sub Name loop, it never refers to using it for a Dependent. It specifically states it is for the Sub. In our plan each mem. Has a unique member number. Does this mean that each of our members is a subscriber?

Submitter Assigned Keywords

when to use subscriber and dependent loops

Response

This issue is explicitly addressed in guide 004010X093. Section 1.1 states "This implementation guide focuses on the use of the 276 to request
the status of a health care claim(s)...". Therefore, the question as to whether a dependent with a unique identifier is reported as a dependent or a subscriber is answered by whether the claim in question identified the dependent as a dependent or a subscriber. This means that all of your members can be considered subscribers. Specific usage in the 276 will be contingent upon how they were represented in the specific claim(s) in question.
Submission 5/25/2006
Status Date 5/26/2006
Status F - Final
Primary References
Document 004010x093
Section2100D
Page100
Set IDSub