Change Request Detail
No.
1157
Date
5/13/2011
Submitter
Type of Request
Institutional Claim (UB-92)
Status
DSMO Process Completed
Business Reason
Errors noticed in the 005010X223A2 document:

1. Loop 2300 "Claim Information" - Position 1300 - CLM "Claim Information" segment:
"TR3 Example: CLM*12345656*500***11:A:1*Y*A*Y*I~"
Note that CLM06 is now NOT USED. But the TR3 example has a "Y" in that field.


2. Loop 2300 "Claim Information" - Position 2310 - HI - "Value Information" segment:
"TR3 Example: HI*BE:08::1740*BE:A7::940~"
Note that HI01-04 and HI02-04 are both "Date Time Period" component elements, and NOT USED in the HI- Value Information segment. The example indicates otherwise. There should be an extra component element separator (:) in both HI02 and HI03.

So the corrected TR3 example should be: "HI*BE:08:::1740*BE:A7:::940~"

(In the 4010 guide, the example for this segment got it right: "HI*BE:08:::1740~")


3. Loop 2320 "Other Subscriber Information" - Position 3100 - OI "Other Insurance Coverage" segment:
"TR3 Example: OI***Y*B**Y~"
Note that OI04 is NOT USED. But the TR3 example has a "B" in that field.
(The 4010 guide example had it right.)


4. Loop 2330A "Other Subscriber Name" - Position 3550 - REF "Other Subscriber Secondary Information" segment:
The only allowed value for REF01 in this segment is "SY - Social Security Number". So why is this segment allowed a repeat of 2?

Thank you.

Suggestion
Suggested Fixes:

1. Loop 2300 "Claim Information" - Position 1300 - CLM "Claim Information" segment should read:
Corrected TR3 Example:   CLM*12345656*500***11:A:1**A*Y*I~
(The 'Y' in the CLM06 position present in the current example should be removed as it is 'NOT USED'.)


2. Loop 2300 "Claim Information" - Position 2310 - HI - "Value Information" segment should read:
Corrected TR3 Example:   HI*BE:08:::1740*BE:A7:::940~
(An extra component element separator (:) has been added in both HI02 and HI03.)


3. Loop 2320 "Other Subscriber Information" - Position 3100 - OI "Other Insurance Coverage" segment:
Corrected TR3 Example: OI***Y***Y~
(The OI04 is 'NOT USED', so the "B" in that field should be removed from the example in the current version of the TR3.)


4. Loop 2330A "Other Subscriber Name" - Position 3550 - REF "Other Subscriber Secondary Information" segment should have a repeat of 1 only. Since the allowed value for REF01 in this segment is "SY - Social Security Number" and it is hard to conceive of any system allowing for an individual to have more than one SSN.
DSMO Category
C
Recommendation
Approve. ASC X12 continues to work with their publisher during development of future versions on items such as better representation of  examples for both current sample data and consistency with TR3 implementation, as well as consistency of loop repeats and allowable qualifiers.

Appeal Recommendation