Change Request Detail
No.
841
Date
9/12/2003
Submitter
Type of Request
Claim Status Request and Response
Status
DSMO Process Completed
Business Reason
Addenda 004010X093A1 changed the 2200D/TRN segment from situational to required.  This causes a 2200D loop to be required when the inquiry is for a dependent.  Usage notes state that 'Use of this segment is required if the subscriber is the patient'.  We believe this change to have been an error.
This is creating compliance errors and forces system changes to account for discrepancies in the implementation guide.
Suggestion
Change 2200D/TRN usage to situational.  Required when subscriber is the patient.

For clarity, we would expect the overall usage of the subscriber HL (22) to be:
2000D/ Required
2100D/ Required
2200D/ Situational (usage: required when subscriber is patient)
2210D/ Situational
DSMO Category
D
Recommendation
Disapprove. The Addenda actually changed the usage of the 2200D TRN from Required to Situational, not Situational to Required.  The Situational usage is based on whether or not the patient is the insured.  The addenda change meets the requestors suggestion.
Appeal Recommendation