Please explain the compliant use of the 5010x279 III segment and/or other segments to convey place of service in the following scenario:
If a benefit is applicable to more than one place of service, for example, the benefit is applicable to both Office and Home place of service, is the following a compliant way to convey this?
EB*A*IND*9***27**.2****W~
III*ZZ*11~
III*ZZ*12~
We have received an error from a trading partner stating that this is not compliant. The only segment in the 2115C/D loop is the III segment and the loop can repeat up to 10 times.
The example you provided is compliant with the 00510X279A1 TR3. The purpose of the III – Subscriber or Dependent Eligibility or Benefit Additional Information Loop/Segment is to identify limitations in the benefits explained in the corresponding Loop 2110C or 2110D such as if benefits are limited to a type of facility. The loop repeat is 10. Therefore, 10 different Facility Type Codes can be sent for each 2110C or 2110D loop.
TR3 note 4 states “Use this segment only one time for the Facility Type Code”. This note only restricts the use of each Facility Type Code to one usage per 2110C or 2110D loop.
This note was further clarified in subsequent versions of the 271 to read as follows:
“Use the SUBSCRIBER ELIGIBILITY OR BENEFIT ADDITIONAL INFORMATION loop to identify each Facility Type Code associated to the benefit being returned in loop 2110C. Each 2115C III02 Facility Type Code must be used only once within 2110C loop.”