I have a request for clarification regarding the use of the HI (Patient Diagnosis) segment within the 005010X215 transaction. The Situational Rule states: Required when valued on the inquiry and used by the UMO to search for authorizations. This implies it is search criteria. However, if this field is intended to represent search criteria, which field should be used to repsent the diagnosis code assigned to the Authorization itself? If the 2000E/HI field is intended to represent the diagnosis code indicated on the Authorization, then it does not provide enough sesgments for the trading partner to return all diagnosis codes that were originally indicated.
The 278 request for authorization provides multiple diagnosis code fields, however in this transaction only one code is allowed. Pelase let me know if you have any guidance on this issue.
When the HI is submitted on the inquiry request, it is used as search criteria and the associated response will contain all event history that matched that diagnosis code.
The HI on the response is intended to represent the diagnosis code that was submitted as search criteria on the 278 inquiry. We understand that limiting the HI repeat in the response to have 1 diagnosis code didn’t meet the industry need, therefore, this has been expanded in the next version to support 12 diagnosis codes.