Section title: Requests for Interpretation
RFI #
2427
2200D 2200E REF02 (276/277)
Description

For the 276/277 (005010X212) If an Inst bill type code is on a Prof Claim, is that non-compliant? It appears that the system sometimes moves/maps the 837P reported professional place of service code to the institutional Bill Type field. This then results in the 277 Health Care Claim Status Response for a professional claim to include an institutional REF*BLT segment.
The Segment identified in the request is:
REF - INSTITUTIONAL BILL TYPE IDENTIFICATION
REF02-SEGMENT SYNTAX: R0203

This is a follow up question to RFI 2383. 2383 answered the question but only mentions Loop 2200D. Would the response also apply to Loop 2200E?

Response

Loop 2200E Institutional Bill Type Identification REF is used to report data for institutional claims only. While the segment situational rule allows the segment to be sent at the sender’s discretion, when sent, the segment can still only contain data that originated on an institutional claim. The data sent in REF02 is limited to the concatenation of the following code sources:

-          236 Uniform Billing Claim Form Bill Type

-          235 Claim Frequency Type Code.

Therefore, Place of Service codes from the 837 Professional claim are not compliant with the TR3.

DOCUMENT ID
005010X212