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Back  RFI # 1313: 1.4.7.1 Minimum Req 270/271

Formal vs. Informal Help Informal Formal

Submitter

karthik Subramanian

Description

Hi,

Point no: 8 of section 1.4.7.1 section of the 270/271 TR3 front matter, you have the following statement following all required service type for 30:

'The above codes must have the appropriate EB01 = 1-5.'

What is the intent of requiring this information at all times? Would it be redundant information, if the Payer is returning Patient Liability, which implicitly would convey that the member is 'active'? Without an Active status there would be no reason to return Patient Liability?

Please advice.

karthik Subramanian
Blue Cross Blue Shield Association
312.297.6150
karthik.subramanian@bcbsa.com

Response

This is explicitly addressed in section 1.4.7.1 Item 8. It is required to return the EB01 1-5 for each of the 10 service type codes included in the response to a EQ01=30 or an explicit service type code that is not supported. Although the active status can be “inferred” due to the returning of patient financial responsibility and other benefits, there is no requirement to return patient financial liability or other information in 005010X279. Therefore, 1.4.7.1 Item 8 defines the minimum every 271 response will include for a request of EQ01=30 or unsupported service type code. Returning patient financial liability or other benefit information but not returning an EB01=1-5 for one of the 10 included in 1.4.7.1 Item 8 results in a 271 not compliant with this TR3.

If everything is the same within the 2110C/D loop with the exception of the EB03 value, the repeating data element must be used. With this requirement, it streamlines the response regardless of the existence of patient financial liability and/or other information.
Submission 5/2/2011
Status Date 7/22/2011
Status F - Final
Primary References
Document 005010X279
Section1.4.7.1
Page21
Set ID8