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Back  RFI # 993: Sequence of REF Prior Auth Seg

Formal vs. Informal Help Informal Formal

Submitter

Louise Clark

Description

Do the REF Prior Authorization and Referral segments need to be submitted in order, ie. one right after the other (REF*9F followed REF*G1 or vice versa) when both segments are sent by a submitter? For example, is the following submission compliant:

REF*G1*6429684~
REF*EA*723-5746~
REF*9F*804007900~

We have two HIPAA validation tools that allow the segments to be submitted in any sequence. However, our transformation software is expecting the REF*G1 and REF*9F to follow each other. The vendor has sent us excerpts from the X12 standards which they state mandate the order - 3.8.3.1 Repeated Occurrences of Single Data Segments
and 3.8.4.4 Data Segment Order.

This is specifically about a situation where a function that can repeat is separated by another instance of the segment from the same position. i.e.- G1 and 9F are part of an REF with 2 repeats separated by a different REF instance, as above.

Submitter Assigned Keywords

REF Prior Authorization Referral Number Sequence

Response

This issue is explicitly addressed in guide 004010X098. For both the referenced REF segments, the Standard section identifies the REF segment position as 180 in table 2. Therefore, all business uses for this REF segment (position 180) are at the same logical location within the transaction set and the relative order of their occurance within a specific 837 transaction does not matter. This is independent of the fact that the one segment instance is listed with a max use of 2.

The referenced sections are from X12.6, which is the Application Control Structure and defines the structure of the ASC X12 standard and its symbology. It is not stating implementation parameters. The applicable sections for this issue are in ASC X12.59 (IMPLEMENTATION OF EDI STRUCTURES-SEMANTIC IMPACT), section 5.7 (Segments within a loop) and 6.2 (Order Independence).
Submission 3/16/2010
Status Date 4/15/2010
Status F - Final
Primary References
Document 004010X098A1
Section3.1
Page53
Set ID837
Loop2300
Segment Position180
Segment IDREF