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Back  RFI # 216: EQ Segments in both 2110C & D

Formal vs. Informal Help Informal Formal

Submitter

Mark Keitel

Description

Sender wants to put (270A1) EQ Loops in both Subscriber AND Dependent loops when the request is for a Dependent. It is my understanding that this is incorrect as the note 2 says that this loop should only be used when the Subscriber is the patient. Sender is contending that since it is not stated explicitly that there cannot be 2 EQ Loops, they put them in both loops, always.
Are 2 EQ loops, one in 2100C and one in 2100D, a correct implementation of the Guide?

Submitter Assigned Keywords

EQ Loops

Response

Page 89 Note 2 states “Use the EQ loop/segment when the subscriber is the patient whose eligibility or benefits are being verified. When the subscriber is not the patient, this loop must not be used.”

Page 108 note 1 states “Use the Dependent Level only if the patient is a dependent of a Member”.

If the transaction is being utilized in a Real Time mode Section 1.3.3 states “It is required that the 270 transaction contain only one patient request” unless the information source desires to support multiple patient requests.

If the transaction is being utilized in a Batch mode Section 1.3.3 states “It is required that the 270 transaction contains no more than ninety-nine patient requests.”

It would be incorrect to submit a 270 request in Real Time with multiple patient requests in a 270 if the Information Source does not wish to support multiple patient requests. If this is a Batch transaction, a 270 request can contain patient requests (EQ loops) in both the subscriber and patient levels.
Submission 3/10/2005
Status Date 5/16/2005
Status F - Final
Primary References
Document 004010X092A1
Section2110C
Page89
Set ID2110C
Loop2110C
Segment Position22
Segment IDEQ
Industry NameEligibility or Benefit Inquiry Loop