Change Request Detail
No.
791
Date
3/25/2003
Submitter
Type of Request
Professional Claim (HCFA 1500)
Status
DSMO Process Completed
Business Reason
I believe that the Usage on a segment/loop is incorrect.
Suggestion
In the 837P Imp Guide (X098), the OTHER SUBSCRIBER NAME (NM1 in loop 2320A) segment shows usage as "Required."  However, the note for this segment (which is also the beginning of the loop) states "...required when Loop ID-2320 - Other Subscriber Information is used. Otherwise, this loop is not used."  So shouldn't the segment be marked as "Situational?"

I checked 004050X143 (November 2002, Review 2), and the change has not yet been made there.
DSMO Category
D
Recommendation
Disapprove.  Both the 2330A (Other Subscriber Name) and the 2330B (Other Payer Name) loops are Required and are subordinate to the 2320 (Other Subscriber Information) loop in all three claim guides.  According to X12 syntax, when the first segment in a loop is required, the entire loop is required.  In this case, however the 2330A and 2330B loops are only required inside a 2320 loop, which is Situational.
Appeal Recommendation