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Back  RFI # 1985: Plan Number in the 271

Formal vs. Informal Help Informal Formal

Submitter

Kenneth Greenspan

Description

In the 271 transaction, there's a 2100C/REF02 where REF01 = 18, which stands for "Plan Number". I am wondering what type of data payers should generally send for the Plan Number. For example, could a payer (say Good Health Care) send "GHC" for their overall plan, or send a subsidiary plan number to denote a plan in another region, or a tiered plan like Gold, Silver, Bronze, and so on? In general, can the value be pretty much anything the payer wants to send?

Submitter Assigned Keywords

Plan Number 271 REF

Response

The 005010X279A1 TR3 for the 271 transaction, loop-ID 2100C, data element REF02 is Subscriber Additional Information. As stated in the situational rule for the segment, it is "required when the Information Source requires additional identifiers necessary to identify the Subscriber for subsequent EDI transactions". When loop-ID 2100C, data element REF01 has a value of "18 - Plan Number", the REF segment TR3 Note 2 applies, and should be interpreted as, "The type of reference number is determined by the qualifier in REF01. Use this segment to supply an identification number other than or in addition to the Member Identification Number." Loop-ID 2100C, data element REF02 is data type alphanumeric (AN). Consequently, any appropriate value identified by the Information Source -- either internally or as received in an incoming 270 transaction REF segment used to locate the individual is valid.
Submission 10/11/2014
Status Date 1/9/2015
Status F - Final
Primary References
Document 005010X279A1
Section2
Page254
Set ID271
Loop2100C
Segment PositionREF02
Segment IDREF
Element Position02