Change Request Detail
No.
867
Date
4/5/2004
Submitter
Type of Request
Professional Claim (HCFA 1500)
Status
DSMO Process Completed
Business Reason
Dear Sirs:

We have come across an interpretation ‘difference’ between vendors in the 837PA1 Loop 1000A PER segment, element PER02.

The V4010X098 IG (page 72) depicts this element as REQUIRED but with the
following note:

(start IG)
REQUIRED PER02 93 Name O AN 1/60

Free-form name

INDUSTRY: Submitter Contact Name

1816 NSF Reference:

1816 AA0-13.0

2792 Use this data element when the name of the individual to contact is

not already defined or is different than the name within the prior

name segment (e.g. N1 or NM1).

(end IG)


It is not modified in the V4010X098A1 IG.  New syntax says required but the note says situational.  Which one do we enforce?


In the V4050X143 (3MAR2003 Draft) IG (page 70) this conflict has been resolved:

(start IG)
SITUATIONAL PER02 93 Name O 1 AN 1/60

Free-form name

OD: 837Q1_1000A_PER02__SubmitterContactName

INDUSTRY: Submitter Contact Name

1647 Required when the name is different than the name in the Submitter

Name (1000A - NM1) and it is the first iteration of the PER. Not Used

in the second iteration of the PER.

(end IG)


Also, notes during the V4050X143 review process indicate that there was much thought behind the new ' PER02
should be NOT USED in a second iteration'. Source 4050_837P_notes(1).xls
(posted http://www.wpc-edi.com/conferences/)

(start source)
71  1000A - PER02 Situational note does not clearly allow for Not Used when PER is sent twice


Modify note as follows:
Required when the name is different than the name in the Submitter Name
(1000A - NM1) and it is the first iteration of the PER.
Not Used in the second iteration of the PER.

(end source)

This being the case, we see that some vendors are REQUIRING the PER02
element in this case, whereas, others are not.

There are two questions here:

1.    In this specific case, for a V4010X098A1 implementation, should
Loop 1000A PER02 be Required or Situational?
2.    For ‘contradictory’ cases such as this, should the V4050* IGs beused for implementation guidance.



Your interpretation is greatly appreciated,

Stephanie Fetzer

Ascential Software Inc.
Suggestion
Would really appreciate a written decision on this topic to guide our 4010 implementation.
DSMO Category
D
Recommendation
Disapprove as these are questions, not a change request. This change request has been determined to not meet the requirements of a change request. The submitter was contacted and given procedures about submitting a Request for Interpretation (RFI) to X12. The questions have been discussed and are being processed as part of the X12 RFI process. A formal letter will be sent to the submitter upon conclusion of the X12 process.
Appeal Recommendation