RFI #
1691
271 plan max mayment exclusion
Description
We have a plan level maximum payment limitation that applies to all covered service type codes except one. I can codify the limitation as follows:
EB*F*IND*30***23*1500.00*****Y~
How can I indicate, in a compliant manner, that this limitation does not apply to service type code 41?
RFI Response
Use EB01 = H (Unlimited) to indicate there is no cap on the benefit.
Using the example from the Description:
EB*F*IND*30***23*1500*****Y~
EB*H*IND*41***23******Y~
DOCUMENT ID
005010X279