RE: Which REF are you!?

[Hale, Jonathan]

Title: Which REF are you!?

Within any specific loop you can distinguish one REF segment from another by the qualifier in REF01. For example, in loop 2010AA the REF segment for the BILLING PROVIDER SECONDARY IDENTIFICATION in REF01 you can have:

0B State License Number

1A Blue Cross Provider Number

1B Blue Shield Provider Number

1C Medicare Provider Number

1D Medicaid Provider Number

1G Provider UPIN Number

1H CHAMPUS Identification Number

1J Facility ID Number

B3 Preferred Provider Organization Number

BQ Health Maintenance Organization Code Number

EI Employer’s Identification Number

FH Clinic Number

G2 Provider Commercial Number

G5 Provider Site Number

LU Location Number

SY Social Security Number

U3 Unique Supplier Identification Number (USIN)

X5 State Industrial Accident Provider Number

 

Within the same loop 2010AA the REF segment for the CREDIT/DEBIT CARD BILLING INFORMATION in REF01 you can have:

06 System Number

8U Bank Assigned Security Identifier

EM Electronic Payment Reference Number

IJ Standard Industry Classification (SIC) Code

LU Location Number

RB Rate code number

ST Store Number

TT Terminal Code

 

Notice how these two lists are mutually exclusive.

 

Jonathan Hale

Health New England

-----Original Message-----
From: Dekker, Cory [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, August 20, 2002 5:56 PM
To: '[EMAIL PROTECTED]'
Cc: '[EMAIL PROTECTED]'
Subject: Which REF are you!?

Hi all,

In the 837P (v4010X098), Loop ID 2010AA [BILLING PROVIDER NAME], there are 2 Situational REF Data Segments, with identical Data Elements; "BILLING PROVIDER SECONDARY IDENTIFICATION" and "CREDIT/DEBIT CARD BILLING INFORMATION".

Each REF segment can be repeated up to 8 times and both support the same REF Data Elements, including the REF01 ID codeset.  Like most situational codesets, the Internal HIPAA codeset values are distinct by Data Segment, except for ONE code value:  BOTH of them allow "LU" [Location Number].  Both are SITUATIONAL segments, such that it appears that it could be possible to encounter the latter, without the former, and by the data alone, not easily know which data segment you are looking at.

In reading and re-reading the IG, I have been unable to find a clue as to how to know in a grouping of 4 or 5 REF's in a row, where does SECONDARY INFO end, and BILLING INFO begin.  I also found no mention of this problem in either the Errata or the Addenda drafts.  Granted, as a Payer, we should never receive the second data segment.  However, in theory, our HIPAA compliance validator should be recognizing when it might occur, and reject any transaction which contains it.  [yes, I know, "he implied they might reject a claim!"... I'm still struggling with it myself...]

Am I missing something?  Am I reading things correctly?  Has anyone encountered this before?

Has anyone resolved this, and if so, how?

                                Thanks in advance for all assistance...
                                                -Cory

P.S.  Sorry for the cross-post, but I see this as both a transactional recognition issue, as well as an internal situational codeset issue.

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