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Back  RFI # 215: 271 -Sub/Dep Date

Formal vs. Informal Help Informal Formal

Submitter

Nancy Sloan

Description

When a 270 request is received with a 2110C or 2110D Date of Service expressed as a single date (D8), we return a span of dates (RD8) for eligibility on the 271. This date is the terms of the contract. We've learned that others are returning the beginning date of the contract, but the end date as the date of service requested on the 270, using the logic that future eligibility is not certain. Do you know which is the most common interpretation of 'Eligibility Dates' in 2110C/D? I think either is allowed, just wondered what most payers are doing.

Response

The confusion appears to be arising from the distinction between Dates of Service (DOS) and Eligibility Dates. A compliant 271 for a 270 that includes a specific DOS used in the determination of the 271, must at a minimum indicate that the individual has active coverage for that DOS (see Section 1.3.7).

The following 3 examples are all compliant responses, based on the capabilities of the Information Source with a DOS of 4/1/2005 in the 270.

Minimum Response:
EB*1**30~
DTP*472*D8*20050401~

An information source can indicate a range of dates of active coverage, however if the range is based on the DOS from the 270, the 271 should use a DTP01 of “472” (Service) instead of giving a false end of eligibility coverage.

DOS in request and Eligibility Begin date:
EB*1**30~
DTP*472*RD8*20040101-20050401~

An information source can indicate the actual beginning and end of eligibility if the DOS from the 270 is within that range.

Eligibility Range:
EB*1**30~
DTP*307*RD8*20040101-20051231~

Recommendation

The Eligibility Work Group is developing definitions for terms such as Eligibility for inclusion in future implementation guides. We will also look into adding clarifying examples such as those listed in this response.
Submission 3/9/2005
Status Date 5/16/2005
Status F - Final
Primary References
Document 004010X092A1
Section3
Page240
Set ID270271
Table2
Loop2110c