RFI Browser

Back  RFI # 1186: 5010 270 271 Plan Date

Formal vs. Informal Help Informal Formal

Submitter

Cindy Daniel

Description

Date of Service no longer applies in 270/271. The date is now determined by "Plan Date" (p. 19). The Change Guide discusses the change in Loop 2100C. Instruction is to return the Plan Begin Date. Is it appropriate to send the effective date of Medicaid eligibility, which could be many years ago per Louisiana policy? What is the correct definition of Plan Date as it relates to Medicaid?

Submitter Assigned Keywords

Plan Date Eligibility Begin Date

Response

This is expressly addressed in 005010X279. Instructions for the correct use of codes 291 (Plan), 346 (Plan Begin), 292 (Benefit) and 348 (Benefit Begin) are included in Section 1.4.7.1 271 Item 1. This same section includes the following:

“NOTE: Plan dates represent coverage dates in the plan or program that is being represented in the response. This date does not have to represent the historical beginning of eligibility for the plan, only the most recent plan date(s). For example, Medicaid may only report plan dates in one month periods of time.”

It is not appropriate to return the historical effective date of Medicaid eligibility as the plan date unless it represents the beginning of continuous coverage in the same plan. Only dates associated with the Plan that the person is enrolled in are to be returned as the Plan Dates. The Plan Dates returned in the 271 are for the Plan in effect based on the Plan Date(s) from the 270, or the current date in the absence of Plan Date(s) in the 270.
Submission 10/27/2010
Status Date 12/8/2010
Status F - Final
Primary References
Document 005010X279
Section2100C
Page122
Set ID270
Table2
Loop2100C
Segment PositionSubsc
Segment IDDTP
Element Position03
Component Position12
Industry NameDate Time Period