RFI Browser

Back  RFI # 1123: 270/271 5010 Section 1.4.7.1

Formal vs. Informal Help Informal Formal

Submitter

Malene Davis

Description

270/271 5010 Section 1.4.7.1 271 #2

This states that for each plan for which the individual has active or inactive coverage, a 2110C/D loop is required with EB01 Status = 1, 2, 3, 4, 5, 6, 7, or 8 with 2110C/D EB03 Service Type Code = 30 and Plan Name in EB05 if one exists.

What is the purpose of this statement? If you have a Service Type code that is explicitly for Medical services, does this mean a 271 should contain Dental, Vision, etc. plan eligibility as well as Medical plan eligibility regardless of whether the provider really only needs Medical. Or is this statement specifically for when a Service Type Code of 30 is requested on the 270?

In section 1.4.7.3, it talks about streamlining responses and it seems that if the requirement is to send all active/inactive coverage regardless of the service type code, that this is limiting the amount of streamlining that can take place.

Response

The purpose of Section 1.4.7.1 Item 2 is to return all plans for which the member has coverage whether that is a dental or vision plan, or multiple medical plans. The EQ01 that was submitted on the 270 is not relevant when returning the information as outlined in Section 1.4.7.1 Item 2.

Please note, that Section 1.4.7.1 Item 1 also coincides with Item 2. If multiple plans apply or multiple plan periods apply, the DTP at the appropriate loop level must also be returned with their respective dates. Items 1-7 are static requirements and must be returned on all 271 responses when applicable.
Submission 8/6/2010
Status Date 9/24/2010
Status F - Final
Primary References
Document 005010X279
Section1.4.7.1
Page20
Set ID271