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Back  RFI # 1859: HIX Grace Period Notifications

Formal vs. Informal Help Informal Formal

Submitter

David Feinberg

Description

For each of the multiple status Health Insurance Exchange Grace Period Notifications specified in 45 CFR 156.270(d)(2), Notifications to HHS, and 45 CFR 156.270(d)(3), Notifications to Providers, and in accordance with the provisions of Chapter 5, Section 7.ii, Notice of Pending Claims— to Providers, of the CMS Letter to Issuers for 2014 located at http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/2014_letter_to_issuers_04052013.pdf , which ASC X12 Transactions and/or Type 3 Technical Reports may optionally or should per-mandate be used? For each variant of each such status notifications transactions, which ASC X12 transaction loop-ID and data elements and code values [for data types ID as applicable] should be used to convey the specified data?

Submitter Assigned Keywords

HIX Grace Period Notification

Response

Multiple ASC X12 transaction technical reports may apply to the requirements identified in the referenced regulations and guidance, depending upon the specific timing and circumstances. None of the transaction implementations were written after the establishment of the related requirements, so none of the guides existing as of the date of the requirements identified in the referenced regulations and guidance provides explicit direction for these situations. Specifically:

- There is no current ASC X12 technical report identifying notification to the Department of Health and Human Services.

- There is no current ASC X12 technical report identifying notification to the provider as a notification report.

However, multiple transactions can provide some or all of the related information at various stages of the business process, as identified in the Recommendation below.

Recommendation

Submission 9/22/2013
Status Date 7/9/2014
Status F - Final
Primary References
Document as needed
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