Question

#25-2 use the screenshot to answer the following questions.

benefit filing mappings for emergency services 86

1
match action: file to service - ed 2
msg segment handling: custom msg logic | no msg segment

2
match action: file to service - urgent care 6
msg segment handling: custom msg logic | no msg segment
urgent care
defined msg search logic: \urgent care\

3
match action: do not file
msg segment handling: custom msg logic | no msg segment
ancillaries or anesthesia
defined msg search logic: \ancillaries\ or \anesthesia\

+ add mapping | copy mappings | no match found: file to service - ed 2

part 2 of 3
the following data returns in the x12 message:
ebbemp86*o**y~
msg*maximum savings~

what mapping does it match on and what will the system do?
select one of the following (1 pt)
a. it matches on the first mapping and will file to the service for ed.
b. it matches on the second mapping and will file to the service for urgent care.
c. it matches on the third mapping and will not file.
d. it does not find a match and will file to the service for ed.

Explanation:

Analyze the incoming X12 message segments

The incoming message contains:

$$
LATEXBLOCK0
$$

The MSG segment contains the text "MAXIMUM SAVINGS".

Evaluate the benefit filing mappings sequentially

We evaluate the mappings in order:

1. Mapping 1: Match action is "File to service - ED [2]". MSG segment handling is "No MSG Segment". Since a MSG segment exists in the incoming message, this mapping is not a match.
2. Mapping 2: Match action is "File to service - Urgent Care [6]". MSG segment handling is "Custom MSG Logic" with search logic "URGENT CARE". The incoming MSG text "MAXIMUM SAVINGS" does not contain "URGENT CARE", so this is not a match.
3. Mapping 3: Match action is "Do not file". MSG segment handling is "Custom MSG Logic" with search logic "ANCILLARIES" OR "ANESTHESIA". The incoming MSG text "MAXIMUM SAVINGS" does not contain either term, so this is not a match.

Determine the fallback action

Since no mappings (1, 2, or 3) match the incoming message, the system uses the fallback action defined at the bottom right:

$$ \text{"No match found: File to service - ED [2]"} $$

Therefore, the system does not find a match and will file to the service for ED.

Answer:

• A. It matches on the first mapping and will file to the service for ED.
• B. It matches on the second mapping and will file to the service for Urgent Care.
• C. It matches on the third mapping and will not file.
• D. It does not find a match and will file to the service for ED. (Correct answer)