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Back  RFI # 877: 200E/200F when separate certs

Formal vs. Informal Help Informal Formal

Submitter

Pamela Maklari

Description

What is the correct usage for the 2000E loop when the request contains an admission review in addition to services review (2000F), two separate auths are being created and the response is for the services portion of the request?

Hw would the request be returned for the surgery (2000F)?
Would only the 2000F HL be returned and the 2000E omitted?
If the 2000E must be returned, what information should and should not be returned so that it is not interpreted as a certification related to the admission but rather only the certification for the services portion of the request?
For example: What would UM01 contain - AR or SS? What would HCR01 contain?

Submitter Assigned Keywords

2000E separate response 5010

Response

The 2000E loop is required to be returned if there are no AAA segments at a higher level within the transaction. If the admission review and the service authorization are two separate approvals, then separate transactions are necessary. One transaction would contain the UM01 value of AR for the admission review and the other would contain HS for the service authorization request at the 2000E loop. If they both fall under the same authorization, then the UM01 value on the request would contain AR for admission review and the 2000F loop would contain HS for the service authorization. The authorization is provided in the 2000E loop HCR on the response.
Submission 10/6/2009
Status Date 10/30/2009
Status F - Final
Primary References
Document 005010X217
Section1.11.4
Page24
Set ID278