We need to know how to correctly report limitations in the 271 due to a vendor error telling us that we should be merging service types when they have the same value, DTP, and MSG.
An audit on a 271 transaction, after running through the vendor's system, is asking us to merge service types AD & AE to a single line because everything after the EB06 (DTP and MSG) is the same. We disagree with this assessment because each service type has its own unique benefit accumulator. If these were merged to a single line in the 271, how would they know each individual service type has 30 remaining visits and not a "Combined 30 Remaining"? Likewise, what would happen when service type AD uses one visit with 29 visits remaining, but service type AE still has 30 remaining?
Currently reporting:
EB*F*IND*AD***22***VS*30*N*W~
DTP*356*D8*20240701~
MSG*Rehabilitative~
EB*F*IND*AD***29***VS*30*N*W~
DTP*356*D8*20240701~
MSG*Rehabilitative~
EB*F*IND*AE***22***VS*30*N*W~
DTP*356*D8*20240701~
MSG*Rehabilitative~
EB*F*IND*AE***29***VS*30*N*W~
DTP*356*D8*20240701~
MSG*Rehabilitative~
Audit Correction Proposed:
EB*F*IND*AD^AE***22***VS*30*N*W~
DTP*356*D8*20240701~
MSG*Rehabilitative~
EB*F*IND*AD^AE***29***VS*30*N*W~
DTP*356*D8*20240701~
MSG*Rehabilitative~
The vendor’s "error" and the subsequent recognition that the EB03 repeating data element should be used is correct because—for the snippet of this example (assuming the 2115C/D and 2120C/D loops are also completely consistent)—the EB03 values of AD and AE are the only differences between the blocks of data from EB thru MSG (aside from the 22 and 29 EB06 values).
In other words, the following two representations mean the same thing:
EB*F*IND*AD***22***VS*30*N*W~
DTP*356*D8*20240701~
MSG*Rehabilitative~
EB*F*IND*AD***29***VS*30*N*W~
DTP*356*D8*20240701~
MSG*Rehabilitative~
EB*F*IND*AE***22***VS*30*N*W~
DTP*356*D8*20240701~
MSG*Rehabilitative~
EB*F*IND*AE***29***VS*30*N*W~
DTP*356*D8*20240701~
MSG*Rehabilitative~
=
EB*F*IND*AD^AE***22***VS*30*N*W~
DTP*356*D8*20240701~
MSG*Rehabilitative~
EB*F*IND*AD^AE***29***VS*30*N*W~
DTP*356*D8*20240701~
MSG*Rehabilitative~
The 30-visit maximum on both the service year (EB06 = 22) and remaining (EB06 = 29) are separate on the AD and AE service types. Meaning these each have a 30-visit limitation.
The only times the repeating data element functionality should not be used is 1) when the base or remaining amount is different for each of the service types in EB03 and/or 2) when anything else in the 2110C/D loop is different, which includes the values/information carried in the segments in Loops 2115C/D and 2120C/D.
Here is an example of the base limitation for AD and AE being the same dollar amount, but the remaining amounts are different due to utilization:
EB*F*IND*AD^AE***22***VS*30*N*W~
DTP*356*D8*20240701~
MSG*Rehabilitative~
EB*F*IND*AD***29***VS*20*N*W~
DTP*356*D8*20240701~
MSG*Rehabilitative~
EB*F*IND*AE***29***VS*30*N*W~
DTP*356*D8*20240701~
MSG*Rehabilitative~
Because the base amount indicating both AD and AE service type codes have everything else within the EB segment and within the 2110 loop itself as the same (DTP, MSG), the use of the repeating EB03 is required within one EB segment for the 30-visit limitation per service year.