Section title: Requests for Interpretation
RFI #
1005
Loop2300:HI
Description

2300 Loop: HI - CONDITION INFORMATION segment: It just says Required when condition information applies to the claim. Not sure what it means. Is this segment required for Eye care industry? What is the industry code and do we need to generate HI02 till HI09? From where can we get the code list?

RFI Response

This issue is addressed in guide 005010X222. Condition Codes are one set of codes available from the NUBC under code source # 132. Submitters are responsible for monitoring external code lists and using them when a code represents information applicable to that claim." . Required when Condition Code information applies means, if the condition identified by the code is present, then the Condition Code must be sent. For instance, if an elective abortion was performed Condition Code AH must be sent to identify this condition was present on the claim. Only the conditions present must be sent. If only one condition is present then only the HI02 is sent. Other HI elements would only be sent if numerous conditions were present.

DOCUMENT ID
005010X222