X222 - Can Loop 2400 NTE be used by the provider to send information to the health plan that is required by the plan?
X223 - Can provider use Loop 2400 NTE to send information to a health plan?
X222 - A health plan is requiring use of this LOOP 2400 NTE as an alternative location for providers to use to send them laboratory test codes
NTE *ADD* LAB (test code goes here)
X223 - A health plan is requiring providers to use Loop NTE as an alternative location so them them laboratory codes and the Lab IS NOT a TPO/Repricer
NTE*TPO*LAB (test code goes here)
The Segment (2400 NTE) Situational rule is clear that this is not to be used by Providers.
Situational Rule: Required when the TPO/repricer needs to forward additional information to the payer. This segment is not completed by providers. If not required
by this implementation guide, do not send.
The NTE segment is reserved for use by TPO/repricer when they feel that supporting information is needed for a claim or service line. A payer cannot require the use of the NTE to send information.
The NTE segment is to be sent at the Provider's discretion, not to be required by a Payer.
Situational Rule: Required when in the judgment of the provider, the information is needed to substantiate the medical treatment and is not supported elsewhere within the claim data set. If not required by this implementation guide, do not send.
The NTE segment is reserved for use by providers when they feel that supporting information is needed for a claim or service line. A payer cannot require the use of the NTE to send information
You may submit an X12 maintenance request, if there is a business need not supported in a published TR3, for consideration in a future version of the TR3.