In RFI # 2236, X12 responded that this loop/segment can be repeated 10 times to report POS/facility type codes. Can X12 align this response with the actual TR3 which says that the loop/segment can be repeated 10 times but only be used 1 time for reporting POS/facility type code? Below is the TR3 verbiage:
“Situational Rule: Required when III segments in Loop 2110D of the 270 Inquiry were used in the determination of the eligibility or benefit response.
OR
Required when needed to identify limitations in the benefits explained in the corresponding Loop 2110D (such as if benefits are limited to a type of facility).
If not required by this implementation guide, do not send.
TR3 Notes:
1. This segment has two purposes. Information that was received in III segments in Loop 2110D of the 270 Inquiry and was used in the determination of the eligibility or benefit response must be returned.
If information was provided in III segments of Loop 2110D but was not used in the determination of the eligibility or benefits it must not be returned. This segment can also be used to identify limitations in the benefits explained in the corresponding Loop 2110D, such as if benefits are limited to a type of facility.
2. Use this segment to identify Nature of Injury Codes and/or Facility Type as they relate to the information provided in the EB segment.
3. Use the III segment only if an information source can support this high level functionality.
4. Use this segment only one time for the Facility Type Code.
TR3 Example: III✱ZZ✱21~
III✱✱✱44✱Broken bones and third degree burns~
ASC X12N • INSURANCE SUBCOMMITTEE 005010X279 • 271 • 2115D • III
TECHNICAL REPORT • TYPE 3 DEPENDENT ELIGIBILITY OR BENEFIT ADDITIONAL INFORMATION
So, this is correct:
EB*A*IND*9***27*.2****W~
III*ZZ*11~
EB*A*IND*9***27*.2****W~
III*ZZ*12~
This is not correct:
EB*A*IND*9***27*.2****W~
III*ZZ*11~
III*ZZ*12~
Structurally speaking, Loop 2115C/D is allowed to repeat up to 10 times, the III segment itself is not. The design intent to repeat the 2115C/D loop, despite it only containing one segment (III), was to minimize unnecessary verbosity of the EB loop’s details by instead repeating the Loop 2115C/D rather than Loop 2110C/D when the 2110C/D loop’s segment values remain static in what would be the repeated 2110C/D loops.
The confusion in the applicability of the TR3 note on the III segment begins due to the above structural requirement that a loop can repeat, but the first segment in that loop cannot (reference Application Control Structure (X12.6), Section 3.8.3.2.1 Unbounded Loops). As Loop 2115C/D contains only 1 segment and that segment repeats only 1 time, when Loop 2115C/D is repeated, it can only include a single III segment. However, repeating Loop 2115C/D allows the III to appear, on the surface, like the III segment is repeating, when in fact it is the 2115 loop repeating that the III segment is carried in.
The WG hopes that Example A below explains how to best understand the benefit of the 2115C/D loop repeat, in contrast to using the loop 2110C/D loop repeat:
A
Example of the compliant use:
EB*A*IND*4^5^62***27**.2****W~
REF*9F*Auth12345~
MSG*Insert non-codifiable text~
III*ZZ*11~
III*ZZ*12~
III*ZZ*21~
III*ZZ*22~
III*GR*1234~
III*NI*1432~
Each III segment is within its own 2115C/D loop and technically should contain different values to differentiate the need for the loops’ repeats.
To clarify, the intentional benefit of repeating the 2115C/D loop up to 10 times is to avoid the repetition of Loop 2110C/D EB (and segments in that loop) just to send different places of service in Loop 2115C/D, essentially resulting in technical inefficiency; the following example depicts a compliant, yet unnecessarily verbose way to share the same information that is communicated more simply and cleanly via Example A above:
B
Example of 271 2110C/D loop with its segments and having a single occurrence of 2115C/D loop, with different III02 values:
EB*A*IND*4^5^62***27**.2****W~
REF*9F*Auth12345~
MSG*Insert non-codifiable text~
III*ZZ*11~
EB*A*IND*4^5^62***27**.2****W~
REF*9F*Auth12345~
MSG*Insert non-codifiable text~
III*ZZ*12~
EB*A*IND*4^5^62***27**.2****W~
REF*9F*Auth12345~
MSG*Insert non-codifiable text~
III*ZZ*21~
EB*A*IND*4^5^62***27**.2****W~
REF*9F*Auth12345~
MSG*Insert non-codifiable text~
III*ZZ*22~
EB*A*IND*4^5^62***27**.2****W~
REF*9F*Auth12345~
MSG*Insert non-codifiable text~
III*GR*1234~
EB*A*IND*4^5^62***27**.2****W~
REF*9F*Auth12345~
MSG*Insert non-codifiable text~
III*NI*1432~
In summary, as shown by Example A above, the point of the repeating 2115C/D loop structure is to take direct advantage of the data present in the 2110C/D Loop and its segments while not having to repeat, as shown by Example B, the EB, REF, and MSG segments each time a different 2115C/D segment is needed for a different place of service or nature of injury code. To put it another way, the use of 2115C/D as a preference when all things in the 2110C/D loop remain constant/static is encouraged and preferred over the use of 2110C/D repeating.
In subsequent versions of the TR3 guide, the use of III as a segment has been clarified.