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Back  RFI # 2220: Eligibility Benefit Renewal

Formal vs. Informal Help Informal Formal

Submitter

Dennis Zanetti

Description

Use case: member has active coverage from 1/1/2017 – 12/31/2019 but the group renewal date & the benefits reset June of every year.

Plan wants to communicate the June 1 date on which the benefits renew.

One suggestion was to communicate the renewal date at the benefit level (DTP01=539), but our health plan wants to be able to communicate this date at the subscriber level so they do not have to communicate this for every benefit (benefits reset at a plan level, not at a benefit level).

Which DTP01 qualifier should be used to communicate the date on which benefit accumulators reset? There does not seem to be an appropriate qualifier for this scenario.

Submitter Assigned Keywords

eligibility benefits reset date

Response

There is not a specific qualifier in the 2100C DTP – Subscriber Date to report the renewal of plan benefit maximums per se.
At the 2110C level in the EB Subscriber Eligibility or Benefit Information segment, an EB03 value of ‘30’ (Health Benefit Plan Coverage) could be used to indicate the related dates apply to all plan benefits. Then within the 2110C DTP – Subscriber Eligibility/Benefit Date the qualifier for ‘period start’ or ‘benefit begin’ date could be used to report the benefits renewal date. Furthermore, the 2110C MSG segment may also be used when the eligibility or benefit information cannot be codified in existing data elements (including combinations of multiple data elements and segments); AND when this information is pertinent to the eligibility or benefit response to give a further explanation of what the Subscriber date being reported is.

Recommendation

If you have a business need not supported in a published TR3, you may submit an ASC X12 change request for consideration in a future version of the TR3. Change requests are submitted at http://changerequest.x12.org/
Submission 7/6/2017
Status Date 8/11/2017
Status F - Final
Primary References
Document 005010X279
Section2.6