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Back  RFI # 750: Other Payer and Member Info

Formal vs. Informal Help Informal Formal

Submitter

Stuart Beaton

Description

Is this the correct way to return Other Payer and the associated member information using the 004010X092A1 Implementation Guide?

EB*R~
REF*1W*123456789~
LS*2120~
NMI*PRP*2* Health Plan Name~
LE*2120~
EB*R~
REF*1W*123456789~
LS*2120~
NMI*IL*1*Member Last Name*First Name****MI*123456789~
LE*2120~

Submitter Assigned Keywords

Other Payer linkage to Member

Response

Yes, the example given is the correct way to return Other Payer and the associated member information using the 004010X092A1 Implementation Guide.

The structure of the 004010X092A1 271 transaction did not allow for the efficient linkage of the other health plan and the other health plan member information. This linkage can be accomplished by returning two separate 2110 loops with EB01 = R (Other Payer) and the Member ID number in an associated REF segment with REF01 = 1W in both loops. One iteration of the 2110 loop will identify the other health plan, and a second iteration of the 2110 loop will identify the member. The order of the 2110 loops does not specifically need to be in the order shown, nor do they need to follow each other though it is recommended that they do for ease of understanding the relationship to each other.

Recommendation

If the member ID is not available, if the information associated with one of the other values in the 2110 REF01, you may use it in both loops to provide the same type of linkage.
Submission 3/27/2009
Status Date 5/18/2009
Status F - Final
Primary References
Document 004010X092A1
Section3
Page218
Set ID270271
Table2
Loop2110