This is the perfect time for a discussion of loops and loop usage. Loop usage in X12 syntax is determined by the usage of the first segment in the loop (see A.1.3.11.4.1). For example, the change that was made to the TRN (first segment in the 2200D loop) allows the remaining segments in the loop to not be used based on the situation that the subscriber is NOT the patient.
However, there is a huge problem with inconsistency in the HIPAA IG's. The 270/271 for example shows the intended structure of the 271. Based on that explicit illustration, the 2000B and 2000C loops should be REQUIRED. It is good to question everything and use the HIPAA DSMO process and NPRM comment periods. Jonathan Fox eCommerce Analyst Independent Health CONFIDENTIALITY NOTICE. This e-mail and attachments, if any, may contain confidential information which is privileged and protected from disclosure by Federal and State confidentiality laws, rules or regulations. This e-mail and attachments, if any, are intended for the designated addressee only . If you are not the designated addressee, you are hereby notified that any disclosure, copying, or distribution of this e-mail and its attachments, if any, may be unlawful and may subject you to legal consequences. If you have received this e-mail and attachments in error, please contact Independent Health immediately at (716) 631-3001 and delete the e-mail and its attachments from your computer. Thank you for your attention. >>> [EMAIL PROTECTED] 06/27/02 08:58AM >>> Hal, I agree with your reading of the IG regarding usage of the STC, but, unfortunately, am not able to control how the IG has been interpreted by third parties. Both our EDI translator and the third party web application we will use for certification have built the rules using a strict reading of the "REQUIRED" in the guide, without consideration of the notes. I expect this is the sort of issue that will be worked out during testing with an outside entity. -----Original Message----- From: Hal Scoggins [mailto:[EMAIL PROTECTED]] Sent: Wednesday, June 26, 2002 2:41 PM To: [EMAIL PROTECTED] Subject: RE: 277 STC at Subscriber level Michael, Regarding the TRN and DMG segments, we coded to the addendum, assuming it will be effective by the deadline date. The way I read the IG, the STC is not required at the Subscriber level if the Subscriber is not the Patient. I'm looking at note #1 on IG page 154. Granted that, technically, the Usage should have been changed to SITUATIONAL, as the TRN was. But the note lets us off the hook, IMO. In short, we're treating the STC at the Subscriber level as SITUATIONAL. BTW, my copy of the addendum adds a note to the DMG segment (addendum page 19, replacing original IG page 148), as well as changing the Usage, letting us off the hook there. Is your copy different? Hal Scoggins SBPA Systems, Inc. (281) 679-7272 x116 -----Original Message----- From: Lachenmayer, Michael [mailto:[EMAIL PROTECTED]] Sent: Wednesday, June 26, 2002 11:40 AM To: '[EMAIL PROTECTED]' Subject: 277 STC at Subscriber level The 4010 guide for the 276/277 has various segments on the 277 required at the subscriber level, even if the claim is not for the subscriber. Examples are the DMG, TRN, and STC. This is in conflict with note at the end of section 2.2.3.1.1 (pg 27), which says that claim related information should 'float', being placed at the level of the patient to whom the claim applies. While 4010a fixes this problem for the DMG and TRN (though the DMG change is not identified!), it does not change the STC requirement. How are you handling this requirement, especially in the instance where you have more than one dependent for the same subscriber, each with a claim with its own status? Or one dependent with multiple claims, each with its own status. Are there generic status and category codes which can be used at the subscriber level? Thanks for you help. Michael Lachenmayer Independence Blue Cross Ph: (215) 241-9453 Fx: (215) 241-4134 CONFIDENTIALITY NOTICE: This E-Mail is intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you have received this communication in error, please do not distribute and delete the original message. Please notify the sender by E-Mail at the address shown. Thank you for your compliance. ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ====================================================== The WEDI SNIP listserv to which you are subscribed is not moderated. 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