RFI #
2788
Clarification of EPSDT Referral Segment Situational Rule
Description
Could you please clarify the Situational Rule conditions for the Loop 2300 CRC - EPSDT Referral segment? Is the situational rule always satisfied if any of the contained Loop 2400 SV111 (EPSDT Indicator) fields are set to "Y" (Yes)? Would the situational rule ever be satisfied even if none of the SV111 fields are set? Would the situational rule ever not be satisfied even when at least one SV111 field is set?
Scenario
We want to ensure that our claim edits are correct.
RFI Response
2300 CRC - EPSDT is used for any screening service being billed in this claim, and 2400 SV111 indicates when Medicaid services are the result of a screening referral. 2300 CRC - EPSDT and 2400 SV111 must be evaluated independently as they have separate requirements.
DOCUMENT ID
005010X222