Section title: Requests for Interpretation
RFI #
893
Using Repeating Data Element
Description

When to use/not use REPEATING DATA ELEMENT w/Limits/Max (EB01=F). Per the TR3, REPEAT DATA ELEMENT s/be used when all info in the 2110C loop is same w/the exception of the ServType code in EB03. Below are ex of when the REPEATING DATA ELEMENT will/will not be use. Is this correct?

Example 1 - Dental/Vision have a combined $ max of $1500/yr. The member used $600, there is $900 remain.

EB*F**AL^35***23*1500*****W~

MSG*Combined vision and dental Limit~

EB*F**AL^35***29*900*****W~

MSG*Combined vision and dental Limit~

Example 2 - Dental/Vision have an ind $ max of $1500/yr. The member used $600 for dental, there is $900 remain & zero for vision, so there is $1500 remaining.

EB*F**AL^35***23*1500*****W~

EB*F**35***29*900*****W~

EB*F**AL***29*1500*****W~

Response

The repetition element is used when all information previously would have been reported with multiple EB segments and any other segments within that same 2110 loop would have contained the same information, and the only difference is the Service Type Code in EB03. The repetition element is not intended to be used to combine benefits into one category. Currently the MSG segment is the only way to indicate that benefits are combined as you have included in your first example.

The first scenario with using the repetition function to combine benefits and a message segment is correct; however recipients of example 1 may misinterpret the response.

The second scenario is correct.

RFI Recommendation

5010 examples and how the same information would have been returned in 4010:

EB*F**AL^35***23*1500~

MSG*Combined vision and dental Limit~

Would have been returned in 4010 as:

EB*F**AL***23*1500~

MSG*Combined vision and dental Limit~

EB*F**35***23*1500~

MSG*Combined vision and dental Limit~

EB*F**AL^35***23*1500~

Would have been returned in 4010 as:

EB*F**AL***23*1500~

EB*F**35***23*1500~

DOCUMENT ID
005010X279