RFI Browser

Back  RFI # 1717: 271 2110C/D Multiplan coverage

Formal vs. Informal Help Informal Formal

Submitter

john bourget

Description

For situations where a 271 is reporting coverage under two different plans, the guide requires sending one 2110C/D loop for each plan with EB01- 1,2,3,4,5,6,7 or 8 and EB03=30. However, there appears to be no specific association then between detail 2110C/D loops with the specific plan. What method should be used to associate the specific benefits with the correct plan? Should the Plan Name (EB05) or the Plan Date (DTP segment) or something else be used? See the following snippet. There is no association apparent between the benefits unless you assume a meaning to the order which is not appropriate as we understand the ASC X12 syntax.

EB*1*FAM*30**PPO Plan A~
DTP*346*D8*20090101~
EB*B**98***23*15*****W~
EB*1*FAM*30**PPO Plan B~
DTP*346*D8*20110101~
EB*B**98***23*19*****W~

Is a valid solution the following change?

EB*1*FAM*30**PPO Plan A~
DTP*346*D8*20090101~
EB*B**98**PPO Plan A*23*15*****W~
EB*1*FAM*30**PPO Plan B~
DTP*346*D8*20110101~
EB*B**98**PPO Plan B*23*19*****W~

Submitter Assigned Keywords

EB DTP Loop 2110C

Response

The example above is compliant with the requirements of 005010X279A1. The use of EB05 identifying the different plan names that are associated with the specific benefits would be appropriate. Including the plan dates would be helpful to the receiver of the transaction in differentiating when the different plans are effective.

Recommendation

If the plan end date is also known it should also be included, especially if one of the plans has ended.
Submission 12/11/2012
Status Date 2/19/2013
Status F - Final
Primary References
Document 005010X279
Section2.6
Page289
Set ID271