This request is in reference to the TR3 for the HIPAA 5010 837 Professional Guide usage of the Loop 2000B SBR 03 and SBR 04 segments respectively.
Our interpretation of the use of these elements is as follows and we are seeking clarification and support of, if appropriate, our interpretation.
In the event that Loop 2000B SBR03 is valued, Loop 2000B SBR04 must not be valued. Referring to the SBR04 "Required when SBR03 is not used and the group name is available. If not required by this implementation guide, do not send."
Conversely, in the event that Loop 2000B SBR03 is not valued, Loop 2000B SBR04 may be valued.
Valuing both Loop 2000B SBR03 and Loop 2000B SBR04 would not be an allowable action.
Thanks in advance for your time and interpretation.
Yes, submitting both the 2000B SBR03 and SBR04 on the same claim is not compliant with the guide.
The rule for the SBR04 reads “Required when SBR03 is not used and the group name is available” If the SBR03 is populated then the SBR04 must not be sent.
Review RFI 1512 for information regarding processing non-complaint transactions