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Back  RFI # 633: K3 Segment in Loop 2300

Formal vs. Informal Help Informal Formal

Submitter

Barb Moskal

Description

Per the IG it states that at the time of puplication K3 segments have no specfic use. It goes on to say that is may only be used if a state concludes it must use the K3 to meet emergency legislative requirements. Does this still hold true? As a payor, are we able to use it for data that the provider wants to send that does not appear to be mapable to any other Loop or Segment?
Thank you.

Response

This issue is explicitly addressed in guide 004010X098. Note 1 on the 2300 loop K3 segment states "...However, they have been included in this implementation guide to be used as an emergency kludge (fix-it) in the case of an unexpected data requirement by a state regulatory authority...." Therefore, this segment cannot be used for data that any payer just wants to use, even if the provider wants to send it.

Recommendation

We recommend usage of the NTE segment for this type of data. The second NTE segment note reads as follows:

Required when: (1) State regulations mandate information not identified elsewhere within the claim set; or (2) in the opinion of the provider, the information is needed to substantiate the medical treatment and is not supported elsewhere within the claim data set.
Submission 2/27/2008
Status Date 4/3/2008
Status F - Final
Primary References
Document 004010X098A
Section1
Page244
Set ID1
Loop2300
Segment PositionK3