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Back  RFI # 2104: 271 with Range for Plan dates

Formal vs. Informal Help Informal Formal

Submitter

Julia Dunicheva

Description

This is a clarification on RFI 2049. This RFI directs to use plan date as Service date for verification of procedure and diagnosis codes.
What date specifically should be used if plan date is sent as a range of dates (DTP02 = RD8)?
What date or part of the date range should be used to identify if ICD-9 or ICD-10 codes should be sent? especially if range spans ICD-10 mandate use date (Oct 1st 2015)?

Response

When eligibility or benefits change during the range specified within the 270, the response 271 must report the separate plan date ranges and benefits using the 2110C/D loop rather than reporting the plan date within the 2100C/D loops. The note on 2110C/D DTP01 code 291 states "Use code 291 only if multiple plans apply to the individual or multiple plan periods apply."

Recommendation

Eligibility Inquiries related to ICD-9 coded diagnoses with Plan Date date ranges should not span beyond 10/01/2015, and Eligibility Inquiries related to ICD-10 coded diagnoses with Plan Date date ranges should not span before 10/01/2015. However, this is a policy and/or Business practice issue outside of the purview of X12.
Submission 10/21/2015
Status Date 12/7/2015
Status F - Final
Primary References
Document 005010X279
Section2.5
Set ID271