Section title: Requests for Interpretation
Interpretation of TR3 - PER-Payer Web Site Segment (Loop 1000A, Payer Identification) (835)

I noticed that the PER - Payer Web Site segment has a change in the Situational Rule in the June 2010. What unsecured URL are we to use in this segment for the health plan?

Are we to specifically use the unsecured URL that links the health plan to their own general policies or to a specific policy?

RFI Response

The 1000A PER Payer web site segment is used to send a URL that links to published appeal, complaint, medical or other policies and those policies are referenced in a 2110 REF Healthcare Policy Identification segment within the remittance advice.

If the payer does not have a published enumerated healthcare policy code list available to providers via an un-secure public website or if there are no claims utilizing the Healthcare Policy Identification segment in the remittance advice, this segment would not be used.

The REF & PER situational rules do not require a payer to create a web site if one does not already exist, nor does is it require a payer to publish their policies on an existing un-secure public site if they do not currently provide that functionality.


RFI Recommendation

If the payer has multiple URLs to their published policies, the URL used can be a web page that identifies links to specific other sites for various policy code lists.  In this way, the URL listed in the 1000A PER Web Site Segment can include links to multiple published policies.  The URL must allow a user to search by the 2110 REF02 healthcare policy code value in the healthcare policy identification segment.