Is it valid for an information source (payer) to use 271 Loop ID-2120C/D to indicate that a member's health plan does not require PCP (primary care provider) selection, or is that information supposed to go in an MSG segment instead? We received the following fragment in a 271:
EB*L*ESP*30*PS~
LS*2120C~
NM1*P3*2*PCP SELECTION NOT REQUIRED~
LE*2120C~
It seems inappropriate to use NM103 for something that is not an actual entity name.
A large commercial payer is using Loop ID-2120C to indicate that a member's health plan does not require PCP selection, and we are unsure about whether this is valid as per the TR3.
Because the condition outlined in the situational rule on the 2120C/D NM1 has not been met, where it advises that the 2120C/D “Required when needed to identify an entity associated with the eligibility or benefits being identified in the 2110C loop such as a provider (e.g. primary care provider), an individual, an organization, another payer, or another information source; If not required by this implementation guide, do not send.” returning “LS*2120C~NM1*P3*2*PCP SELECTION NOT REQUIRED~LE*2120C~” or any other like example that returns a non-organization or non-last name in NM103 would not be compliant with this TR3.
If the payer wants to indicate that a PCP selection is not required, the MSG segment in 2110C/D could be used to convey that information, and any value other than the EB*L could be used to couple with the MSG segment, such as EB*D or EB*CB in EB01.