RFI #
1594
EB01=F (limitation) and HSD
Description
Will you please clarify if the EB01=F (limitation) line is built correct and meets HIPAA requirements for using the HSD segments.
The example below is for our Home Health Care Benefit.
The Home Health Care has a 10% co-insurance patient liability as welll as 120 visits per 12 month period.
Will you please verify which of the below coding examples meet the X12 requirements for using the HSD values.
Example 1
EB*A**42*****.1****W~
EB*F**42*********W~
HSD*VS*120***34*12~
Example 2
EB*A**42*****.1****W~
EB*F**42******VS*120**W~
HSD*****34*12~
RFI Response
Both examples are compliant with the requirements of 005010X279/005010X0279A1. The first example is the preferred method of the two as it keeps the delivery pattern contained in the HSD segment.
DOCUMENT ID
005010X279.