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Back  RFI # 177: Subscriber DMG Requirement

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Submitter

Nadine Farmer

Description

Is there a requirement for the Information Source to populate the DMG date of birth and gender when the subscriber is the patient, the information is available from the Information Source's database and there is no rejection response?

Response

Yes.
The 2100C DMG segment Note 2 States:

“Use this segment only if the subscriber is the patient and if this information is available from the Information Source’s database unless a rejection response is generated and the elements were not valued in the request.”

If the subscriber is the patient, the note on DMG02 (Subscriber DOB) states:
“Required if this is available from the Information Source’s database unless a rejection response is generated and this element was not valued in the request.”

If the subscriber is the patient, the note on DMG03 (Subscriber Gender) states:

“Required if this is available from the Information Source’s database unless a rejection response is generated and this element was not valued in the request.”

Recommendation

Future versions of the 270/271 Implementation Guide clarify the requirement of returning this information and also allow it to be returned when the subscriber is not the patient.
The request did not indicate whether the date of birth or gender was submitted in the 270 request. If the date of birth or gender were submitted, Section 1.3.7 HIPAA Compliant Use of the 270/271 Transaction Set states the following in the last paragraph “The information source is also required to return any information supplied in the 270 request that was used to determine the 271 response. Examples of such information are, but not limited to, service type codes, procedure codes, diagnosis codes, facility type codes, dates and identification numbers.”

If the DOB was supplied in the 270 request and the Information Source used the Date of Birth to locate the individual, they must return it. If the Gender was supplied in the 270 request and the Information Source used the Gender to locate the individual, they must return it.
Submission 1/18/2005
Status Date 3/24/2005
Status F - Final
Primary References
Document 004010X092A1
Section2100C
Page210
Set ID1250
Loop2100C
Segment Position100
Segment IDDMG
Element Position01