How should the information source report benefits that differ based on whether the provider is a general practitioner or a specialist? For example, how would an information source reflect a copay that is $10.00 per professional office visit (service type 98) if the provider is a general practitioner, and $20.00 per office visit if the provider is a specialist?
The information source in this case is not able to identify whether the provider is a specialist or general practitioner based on the provider ID submitted.
If the name or NPI is known of a specific specialist that services are to be performed by, the 2120 loop can be used to identify that specific specialist.
If a specific specialist is not identified, the current 5010 TR3 does not provide a codified way to indicate that a benefit is different when performed by a specialist. The only way to indicate that a benefit is different is to include an MSG segment with MSG01 = "Specialist".
The next version of the TR3 has a codified solution for this.