How would we translate an inpatient copay days segment from the message to the EB segment and/or using the HSD?
Example:
EB*B*IND*48****0****Y*Y~
MSG*Inpatient days 1-7 are 375.00 per day and then 0.00 for after day 8~
Client would like this clarified in code.
There is no codifiable direct way to code this cleanly that would not require some interpretation consistency; however, there are some options that could be considered that may make it easier to convey the above.
This scenario described above does not address what is the copay for day 8 itself. The scenario in the “business scenario” indicates days 1-7 have a $375.00 copay, and beyond day 8, there is a $0.00 copay, but is silent on what happens on day 8. Therefore, this RFI recommendation is addressing the scenario as written, regardless of whether the absence of a copay example for day 8 was not intentional.
EB*B*IND*48***7*375****Y*Y~
HSD***DA**30*0~
HSD***DA**31*7~
MSG*$375 copay per day for days 1-7~
MSG*Our plan covers an unlimited number of days for a Medicare-covered hospital stay~
III*ZZ*21~
EB*B*IND*48***7*0****Y*Y~
HSD***DA**30*8~
MSG*$0 copay per day after day 8 and beyond~
III*ZZ*21~
Related RFI: 2559