Section title: Requests for Interpretation
RFI #
894
Not using Repeating Elements
Description

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

Example 3 - Dental & Vision have separate ind dollar max of $1500/yr. The member used $600 for dental so there is $900 remaining, & used zero for vision so there is $1500 remaining. (This ex has a MSG Txt on the dental line that is not on the Vision line so the REPEATING DATA ELEMENT cannot be used.)

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

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

MSG*Accident Related~

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

MSG*Accident Related~

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

Response

You are correct that if there is a MSG segment in one of the 2110 loops and not in the other 2110 loop, you may not use the repetition function of EB03.

The repetition element is used when all information within the 2110 loops contains the same information, and the only difference is the Service Type Code in EB03.

RFI Recommendation

You may have been able to use code 37 – Dental Accident instead of 35 – Dental Care with a MSG of Accident Related. If the intent of the message is the same as Dental Accident, use of this MSG segment would not be compliant with the requirements of 005010X279 as it can be codified.

DOCUMENT ID
005010X279