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Back  RFI # 1720: 271 2110 Only Dental Plan

Formal vs. Informal Help Informal Formal

Submitter

Barbara Vonasek

Description

Section 1.4.7.1, #2 indicates for each plan which the individual has active or inactive coverage, a 2110C/D loop is required with the status and Service Type Code = 30 (Health Plan Coverage) and Plan Name. We would like to verify if the following is a correct response to a Service Type Code “30” when the health plan includes only a dental plan and no medical plans:

Dependent Eligibility or Benefit Information (2110D)
EB*1**30*PR*XXX STANDARD PLAN P0010~
LS*2120~

Dependent Benefit Related Entity Name (2120D)
NM1*PR*2*XXX SPECIALTY BENEFITS DENTAL*****PI*412014834~
N3*P.O. BOX 5464~
N4*SALT LAKE CITY*UT*84130~
PER*IC**UR*WWW.XXXDENTAL.COM~
LE*2120~
Dependent Eligibility or Benefit Information (2110D)
EB*C*FAM*30***22*150*****W~
EB*C*IND*30***22*50*****W~
EB*G*FAM*30*PR**22*0*****W~
EB*G*IND*30*PR**22*0*****W~
EB*1**35*********W~

Response

The example response appears to be compliant with the requirements of 005010X279A1 Section 1.4.7.1 271 item 2. The example reflects Dental benefits only and that coverage has been carved out to the entity identified in the 2120 loop.
Submission 12/18/2012
Status Date 2/19/2013
Status F - Final
Primary References
Document 005010X279
Section1.4.7.1
Page21
Set ID271
Table2
Loop2110
Segment Position1300
Segment IDEB
Element Position03
Industry NameService type code
Code Value30