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Back  RFI # 439: HSD Segment in 271 and 837

Formal vs. Informal Help Informal Formal

Submitter

Muj Beg

Description

Hi,
The 271 implementation guide shows the following example:
HSD*VS*12*WK*3*34*1~. This is interpreted in the guide as "Twelve visits, three visits per week, for 1 month."

We are receiving a HSD*VS*1*MO*6~ from a payer, which -- per the above example -- we interpret as "Six visits per month". However, this is for Routine (Preventive) Dental, and we have been told should instead be interpreted as "Once every six months."

This 2nd interpretation seems to be supported by the HSD segment example in the 837 implementation guide. The 837 guide states: HSD*VS*1*DA*3*7*21~ = One visit per every three days for 21 days.

The above 837 example seem to contradict the 271 example of the HSD segment. In general we would appreciate some clarification on this issue. We would also like to confirm the proper interpretation of HSD*VS*1*MO*6~ when it occurs in a 271 response.

Thanks,
Muj Beg
Senior Analyst – Special Projects, eServices
KODAK Dental Systems

Submitter Assigned Keywords

HSD Services Delivery 271 837

Response

HSD*VS*1*MO*6~ would be interpreted as One Visit, Six Visits per Month per the example in 004010X092A1. This obviously sends conflicting information and is not the correct use of the HSD segment. The appropriate way to identify One visit every Six months would be HSD*VS*1***34*6~.

HSD01 and HSD02 are used to identify the total quantity of the benefit. The use of HSD03 and HSD04 are to identify how the quantity identified in HSD01 and HSD02 are to be delivered (and would only be of benefit if HSD02 is greater than 1). HSD05 (and if needed HSD06 when a quantity of greater than 1 applies to HSD05) are used to identify the period of time for the use of the quantity HSD01 and HSD02.

The instructions given in the 004010X098A1 837 Health Care Claim: Professional Implementation Guide apply only to the use of the HSD in that transaction.

Recommendation

The 004010X098A1 837 Health Care Claim: Professional Implementation Guide uses the HSD for submission of a treatment plan. This is a different use of the HSD segment than in the 004010X092A1 which uses the segment for submission of a benefit provision. The segment elements are defined differently; therefore, the instructions in the two guides are different.
Submission 8/3/2006
Status Date 10/20/2006
Status F - Final
Primary References
Document 004010X092A1
Section3
Page233
Set ID0
Loop2110C
Segment Position135
Segment IDHSD
Element Position3
Industry NameHEALTH CARE SERVICES DELIVERY