On the TPL portion For this and other things we end up with another EB loop. 2120C is restricted by the IG to one so you will have 4 EB's for TPL. Our TPL reporting needs a 2120C REF to report the policy holder's ID and Name so we are forced into separate EB's if that information is different.
We needed 2120C to be >1 for another reason so I did DSMO request 168 on 2/13/01. It was closed with full agreement and data maintenance number 036101. I was happy and moved on. It didn't make the addenda or 4050 so who knows. -----Original Message----- From: Sparma, Deborah, nashccon To: '[EMAIL PROTECTED]' Sent: 9/17/02 11:34 AM Subject: Handling copay and TPL issues on 271 I am researching a couple of issues on the 271 vs. how we currently do business today and I am finding limitations. For example, our on-line system currently reports to a provider that a subscriber is active, that copay is required, is not required, or is met, and lists all TPL carrier information if applicable. >From what I see in the 271, if copay information is indicated in the EB segment, then monetary values need to be reported in EB07. Since this is a situational element, my question then becomes, if we want to indicate copay in EB01, can we leave EB07 blank to indicate co-pay is required, enter 0.00 in EB07 to indicate copay not required, and put 100% in EB08 if copay max has been met and then indicate in our companion document, user guide (or whatever you want to call it) how these fields are being used? My fear is this use of these fields are against what the spirit of HIPAA is all about. Has anyone else had these issues? On the TPL information, we currently can return 4 TPL carriers and their information to the provider. I was looking at loop 2120C to report the TPL name, address, and contact information, however, this loop only repeats once. Has anyone found a way of reporting more? Thanks for you input. Deborah Sparma ********************************************************************** 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. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited. The contents of this e-mail are intended for the named addressee only. It contains information that may be confidential. Unless you are the named addressee or an authorized designee, you may not copy or use it, or disclose it to anyone else. If you received it in error please notify us immediately and then destroy it. ********************************************************************** 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. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.
