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Back  RFI # 415: Group/Policy Number Reporting

Formal vs. Informal Help Informal Formal

Submitter

Barbara Sesny

Description

There are 3 levels at which this can be reported in the 834. BCBSM is requesting a clarification of the intent of the note associated with REF01 for qualifier 1L in the 2000 loop. It is our understanding from reading the note that the submitter of the 834 should report values assigned by the payer. Our trading parter is interpreting this note assuming that the payer should add their assigned data once the transaction is received.

Response

The intent of the note is to indicate that the payer is responsible for the assignment of the value that would be placed in the element by the submitter.

Recommendation

Have a discussion with your trading partner and come to an agreement about where and how the information required for you to conduct business will be supplied.

DISCLAIMER: X12N's interpretations are intended only to clarify the implementation
guides.
It is not within X12N's scope to comment on the actions of specific entities
such as regulatory bodies, carriers, and providers, nor to render an opinion
on an individual entity's compliance with HIPAA or other federal or state
regulations. Requests concerning interpretations of the HIPAA regulations as
issued by the Department of Health and Human Services should be submitted
via email to askhipaa@cms.hhs.gov.
Submission 6/8/2006
Status Date 8/18/2006
Status F - Final
Primary References
Document 00401095A1
Section3
Page9
Set ID834
Table2
Loop2000
Segment IDREF
Element Position01
Code Value1L