Section title: Requests for Interpretation
RFI #
2316
Place in 837 for indicator
Description

If it is determined that we cannot use Loop 2300/Segment CN1 for a FFS claim, we request guidance in how we can obtain the Contract Type and Contract Code (Level of Care) from providers for a Nursing Home FFS Claim using the X12 837i .

Response

X12 agrees that there is not a way in the v5010 837 Claim transactions to report a ‘Care Plan Option Indicator’ and that this scenario does not meet the Emergency legislation requirements for use of the K3 segment.

RFI Recommendation

The RFI submitter is encouraged to submit a change request to the NUBC to request a new code within the UB-04 code set to address this business need. Otherwise, the submitter can submit an ASC X12 change request it if there is a business need not supported in a published TR3 for consideration in a future version of the TR3. Change requests are submitted at http://changerequest.x12.org/

DOCUMENT ID
005010X223