A payer is requiring that the submitter utilize the 2000F HSD segment to report units whenever 2000F SV1 is present. They do not look at SV103 for number of units even when the procedure does not have a specific pattern of delivery or usage; for example, a colonoscopy. The payer is rejecting a request that contains SV1 but does not contain HSD. Is this compliant with the 5010 x217?
The request 2000F HSD – Health Care Services Delivery segment is “Required when requesting services that have a specific pattern of delivery and the pattern of delivery or usage for this service is different from the pattern of delivery or usage (HSD) in the Patient Event (Loop 2000E). If not required by this implementation guide, do not send.”
It is not compliant with the 5010 X217 TR3 to require that the 2000F HSD segment be sent when the service reported does not have a specific pattern of delivery, and the 2000E HSD segment was not sent, or when there is not a need to identify the number of medical services reservations remaining.
A receiving entity may not include requirements in a trading partner agreement which override the specification in the implementation guide. See section 1.8 for more information on trading partner agreements. Also companion guides may not add, modify or delete any requirements, including loop, segment or element names, notes or rules, examples, appendix, or code list subsets from Section 2 of the associated TR3. For more information on companion guides please see the ASCX12 Intellectual Property statement at http://store.x12.org/store/ip-use.