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Back  RFI # 898: 005010X279-271-EB3 Repeat

Formal vs. Informal Help Informal Formal

Submitter

Am Kal

Description

In 5010>271, EB3 has a repeat of 99. Is it common scenario to use the EB3 repeats? What would be the likelihood of it's repeat?The note in the IG for EB03 on Page 293 says "EB03 is a repeating data element that may be repeated up to 99 times.If all of the information that will be used in the 2110C loop is the same with the exception of the Service Type Code used in EB03, it is more efficient to use the repetition function of EB03 to send each of the Service Type Codes needed....."
The front matter in the IG in section 1.4.7.2 reads as "The repetition function of EB03 must be used if only reporting the Active Status or if Patient Responsibility is the same across multiple benefits."
From the above 2 notes, if we are trying to move 4010 data to 5010 and if 4010 has multiple repeats of 2110C loop which criteria should we be using for repeating EB03? Option 1: EB01, EB07 and EB08 are the same over the repetitions of the 2100C/D loop in 5010 Option 2: All the data of the 2110C be the same.

Submitter Assigned Keywords

EB3 repeat

Response

The repetition function of EB03 must be used when all data in the entire 2110 loop is the same except EB03 across multiple 2110 loops. Those 2110 loops would be combined into one 2110 loop and each of the EB03 values would then be placed in the repeating portion of EB03.

Section 1.4.7.1 addresses some of the scenarios that require the use of the repetition function (and would fall in the criteria of the scenario above), but are not the only scenarios. If the health plan is only reporting the Active Status or if Patient Responsibility is the same across multiple benefits, the repetition function of EB03 must be used, rather than creating individual EB segments for the Active Status or Patient responsibility for each of the benefits.

Both options you identified would require the use of the EB03 repetition function.

Recommendation

The relevant text in Section 1.4.7.1 for 271 item 8 states "The repetition function of EB03 must be used if only reporting the Active Status or if Patient Responsibility is the same across multiple benefits." The text DOES NOT state "The repetition function of the EB03 must ONLY be used if reporting ..."

X12N/TG2/WG1 will consider clarifying this language further in future TR3s to prevent confusion.

“Is it common scenario to use the EB3 repeats?” This will be dependent upon the level of detail returned in a 271 response and will vary from health plan to health plan.

“What would be the likelihood of it's repeat?” Again, this will vary from health plan to health plan.

The correct reference is EB03, not EB3 and the section quoted is actually 1.4.7.1.
Submission 10/22/2009
Status Date 2/26/2010
Status F - Final
Primary References
Document 005010X279
SectionSegment
Page293
Set ID2110C