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Back  RFI # 152: Eligibility Response

Formal vs. Informal Help Informal Formal

Submitter

Patrice Kuppe

Description

I believe this 271 is mapped incorrectly according to what I asked in the 270.

I sent inquiry for patient asking for eligibility for DOS 10/21/04.
Loop 2100C had DTP*472*D8*20041021

The response comes back as active (EB*1) but it shows active dates from 1991! Meaning they are not active for 10/21/04. Is that a correct mapping of EB*1?
Here is the response.

EB*1**30*HM*C
REF*18*H9005
DTP*356*D8*19910701
DTP*357*D8*19910831
Shouldn't that EB01 be a 6?

Submitter Assigned Keywords

271

Response

This issue is explicitly answered in guide X092 in section 1.3.7 on page 20. Section 1.3.7 requires the 271 response "will be for the date the transaction is processed, unless a specific date (prior, current or future) was used from the DTP of the EQ loop". A compliant response would require an EB01 = "6" without the date from the 270 (implying inactive for the date the transaction was processed) or with a DTP with the service date from the 270 transaction if it was used to base the 271 response on.
Submission 11/23/2004
Status Date 1/6/2005
Status F - Final
Primary References
Document 004010X091A1
Section271
Page218
Set ID271