If Im sending more REF segments than a payer needs but Im within the limitations of the IG, can the payer reject the file?
The answer is in the TCS Final Rule, Page 50322, third column: In addition, we note that the intent behind the maximum defined data set was to set a ceiling on the nature and number of data elements inherent to each standard transaction and to ensure that health plans did not reject a transaction because it contained information they did not want. In the first column of the next page it says: In addition, we disagree with commentators that we should add a new usage statement, not required unless specified by a contractual agreement, in the Implementation Guide. We believe that the usage statement would have the same effect as allowing trading partners to negotiate which conditional data elements will be used in a standard transaction. Each health plan could then include different data requirements in their contracts with their healthcare providers. Healthcare providers would then be required to use a variety of guidelines to submit transactions to different health plans. This would def
