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Back  RFI # 2251: 270 Card issue date req'd

Formal vs. Informal Help Informal Formal

Submitter

robert thickens

Description

I am seeing a requirement for a card issue date in an eligibility inquiry companion guide for a payer. I see the requirement listed in the 270 2100C loop in a situational rule that references 1.4.8 but I do not see anything about this being a requirement in 1.4.8 or the Required Alternate Search Option.
Is this something that a payer may require?

Response

The 005010X279A1 270 2100C Loop DTP - SUBSCRIBER DATE segment Situational Rule reads:

“Required when the information receiver wishes to convey the plan date(s) for the subscriber in relation to the eligibility/benefit inquiry. If not required by this implementation guide, may be sent at the sender's discretion but cannot be required by the information source.

OR

Required when utilizing a search option other than either the Primary Search Option or a Required Alternate Search Option identified in section 1.4.8 which requires the ID Card Issue Date. If not required by this implementation guide, may be sent at the sender's discretion but cannot be required by the information source.”

An Information Source (payer) cannot require any additional data elements as a part of the Required Primary Search Option (such as Card Issue Date). Payers can offer additional search options (such as one that utilizes the Card Issue Date), however they must support the Required Primary Search Option and the Required Alternate Search Options as written.

If the payer offers a search option in addition to the Primary Search Option and Required Alternate Search Options identified in section 1.4.8, the payer may require additional data elements to use in its search. If this additional search option requires the ID Card Issue Date, then the second condition of the Situational Rule has been met and that makes the SUBSCRIBER DATE segment required if the submitter of the 270 wishes to take advantage of that additional search option. Requirements for additional search options are communicated to the submitter either by a Trading Partner Agreement or other means.
Submission 10/27/2017
Status Date 1/4/2018
Status F - Final
Primary References
Document 005010X279A1
Section1.4.8
Page124
Set ID270
Table2
Loop2100C
Segment IDDTP
Element Position2
Industry NameCARD ISSUE DATE
Code Value291