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Back  RFI # 194: Subscriber INS segment on 270

Formal vs. Informal Help Informal Formal

Submitter

LYNN YAMASHIRO

Description

If all the data from the mandated search option identified in section 1.3.8 is sent on the 270, can you send the INS segment for the subscriber? More specifically, is the INS segment allowed in loop 2100C when subscriber is the patient and Patient’s Member ID, First Name, Last Name and Date of Birth are also present in the same loop? If so, under what conditions? There is confusion regarding notes on page 85 which seem to limit the use of the INS segment and section 1.3.8 which specifies flexibility to allow a user to enter whatever patient information they have on hand. There appears to be no other place in the transaction to include the birth sequence for multiple births. Would the INS segment be allowed if there needs to be a birth order specified even if all the data for the mandated search option is sent?

Submitter Assigned Keywords

Eligibility 270 INS

Response

The INS segment must not be sent if all of the information is present from the mandated search identified in section 1.3.8 (Patient’s Member ID, Patient’s First Name, Patient’s Last Name and Patient’s Date of Birth). The rationale behind this is that those four pieces of information are unique enough to find a match in the Information Source’s system and there is no reason to collect or use any additional information. In the event of multiple births (twins, triplets, etc.), the first names and the Patient’s Member ID would be unique.

If any one or more pieces of information from the mandated search identified in section 1.3.8 are not present, the use of the INS segment to indicate the birth order in a multiple birth situation may be sent. For example, in the event of twins and the newborns have not been named yet, there would be no first name present to differentiate between the two and the birth order identified in the INS segment would be needed to identify the actual patient.
Submission 2/4/2005
Status Date 3/24/2005
Status F - Final
Primary References
Document 004010X092
Section1.3.8
Page85
Set ID270
Loop2100C