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Back  RFI # 635: Clarification on 'Required'

Formal vs. Informal Help Informal Formal

Submitter

Janice Cunningham

Description

I have a payor who states they are compliant while reported REF01 as null rather than EV due to the explanation listed below. I just need a ruling that Required means Required and it cannot be reported as null for any reason. This would actually apply not just to REF segment, it would apply to any segment / data element when Usage is reported as Required within the 835 IG.

Explanation:
'There are no claims for that RA. There were only two recoup transactions.
The 835 program sets the qualifier 'EV' in the claims section – that means when an RA does not have any claims (which is quite rare), the qualifier EV is not set'

Submitter Assigned Keywords

Usage of Required

Response

This issue is explicitly addressed in guide 004010X091. Section 3 states page 38 "Required this item must be used to be compliant with this implementation guide." While the REF segment in question is Situational, when it is used the REF01 element can not be null. It must contain a valid qualifier value.

The REF01 element is Mandatory in the ASC X12 standard. Section A.1.3.8 states "M- Mandatory The designation of mandatory is absolute in the sense that there is no dependency on other data elements." Section A.1.3.9 states "Any simple data element that is indicated as mandatory must not be empty if the segment is used." Section A.1.3.1.3 states "An identifier data element always contains a value from a predefined list of codes that is maintained by the ASC X12 Committee or some other body recognized by the Committee."

Therefore, if the situation that prompted the use of this segment applies, then all required elements must be populated and not be null. Else the segment should not be valued.
Submission 2/29/2008
Status Date 3/17/2008
Status F - Final
Primary References
Document 004010X091A1
Section3
Page57
Set ID835
Table1
Segment Position060
Segment IDREF
Element Position01
Industry NameReference identification Qualifier
Code ValueEV