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Back  RFI # 2049: 270/271 Date of Service

Formal vs. Informal Help Informal Formal

Submitter

Joyce Petrucci

Description

Currently, in the 270/271, diagnosis codes and procedure codes are only being validated that they exist in the external code lists. There is no further date checking being done, since diagnosis codes and procedure codes must be checked against date of service. There does not seem to be a date of service in these transactions to verify that the code is or would be valid at the time of service.

Question was raised if date checking could be done and if so against which DTP and which DTP01 qualifier?

Neither qualifier seems appropriate: 102 Issue date and 291 Plan

NOTE: Plan dates represent coverage dates in the plan or program that is being represented in the response. This date does not have to represent the historica lbeginning of eligibility for the plan, only the most recent plan date(s). For example,Medicaid may only report plan dates in one month periods of time.

Submitter Assigned Keywords

270 Plan Date Procedure Diagnosis

Response

The 270 2100C DTP – Subscriber Date segment and 2100D DTP – Dependent Date segment TR3 Note 1 reads “Absence of a Plan date indicates the request is for the date the transaction is processed and the information source is to process the transaction in the same manner as if the processing date was sent.” Therefore, if a DTP01 value of ‘291 Plan’ is sent in either segment the subsequent DTP03 date is the date of the eligibility request. If no Plan Date is sent the date of the eligibility request is deemed to be the date the transaction was processed.
Submission 5/11/2015
Status Date 6/15/2015
Status F - Final
Primary References
Document 005010X279
Section1.4.7.1
Page19
Set ID270