Question

#25-3 use the screenshot to answer the following questions.

benefit filing mappings for emergency services 86

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

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\

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

no match found: file to service - ed 2

part 3 of 3
the following data returns in the x12 message:
ebbemp86***0~

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 segment

The incoming X12 segment is:
EBBEMP86***0~

This segment contains:

• EB as the segment identifier.
• 86 in the EB03 position (Service Type Code), which corresponds to "Emergency Services" as indicated by the window title "Benefit filing mappings for Emergency Services [86]".
• No MSG segment is present or specified in the incoming data.

Evaluate the configured benefit filing mappings

1. Mapping 1:

• Match action: File to service - ED [2]
• MSG segment handling: "No MSG Segment"

1. Mapping 2:

• Match action: File to service - Urgent Care [6]
• MSG segment handling: "Custom MSG Logic" (requires "URGENT CARE")

1. Mapping 3:

• Match action: Do not file
• MSG segment handling: "Custom MSG Logic" (requires "ANCILLARIES" or "ANESTHESIA")

Determine the matching mapping

Since the incoming message does not contain an MSG segment, it matches the first mapping, which is configured for "No MSG Segment". Therefore, it will file to the service for ED.

Answer:

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