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Back  RFI # 449: Loop 2300 REF (PA/Referral)

Formal vs. Informal Help Informal Formal

Submitter

vani katta

Description

Would it be HIPAA compliant to submit two repeats of the Loop 2300 REF (Prior Authorization/ Referral Number) with the qualifier for prior authorization (G1)? We were not sure if the two repeats of this segment could only be used if each of the qualifiers is different (e.g. G1 and 9F).

The institutional transaction appears to only allow prior authorization at the claim level. We have scenarios that require two prior authorizations for the various services on the claim. Thanks.

Response

Like qualifiers sent in two Prior Authorization or Referral Number REF segments do not violate the 004010X096A1 Institutional Claim implementation guide. However, submitters should recognize that receivers may have difficulty matching prior authorization or referral numbers to the correct service when two authorizations or two referrals are submitted on the same institutional claim. Receivers may also overlay the first Prior authorization or Referral Number REF with the second received.

Recommendation

The Workgroup strongly recommends that submitters not send more than one prior authorization or more than one referral per institutional claim (that is, per CLM Loop ID-2300).

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 9/8/2006
Status Date 11/10/2006
Status F - Final
Primary References
Document 004010X096A1
SectionClaim
Page193
Set IDREF