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Back  RFI # 2268: 270/271 future date handling

Formal vs. Informal Help Informal Formal

Submitter

Erica Smith

Description

Medicaid has members that may be eligible one month, not eligible the next and then eligible again. When a 270 is submitted with today's date and the member is ineligible this month, it would be helpful to the requester of the next eligible date. We have not found the best way to address this in other RFI's or the X12 guide. For example the 270:
HL*3*2*22*0~
NM1*IL*1*MEMBER*LAURA~
DMB*D8*19530205*F~
DTP*291*D8*20180129~

and the member is eligible 02012018 today the response would be the member is ineligible with no benefits reflecting the impending eligibility.

Submitter Assigned Keywords

future date

Response

Section 1.4.7.1 of the 005010279A1 TR3 contains the following information related to in the future eligibility inquires.

“The response will be for the date the transaction is processed, unless a specific Plan date (prior, current or future) was used from the DTP of the 270.”

“It is recommended that the information source support plan date inquiries for dates in the past as far back as their timely filing limitations are for claims processing and for dates in the future to the end of the current month.”

The 005010X279A1 does not support a codified way to respond to a current date eligibility request and provide future eligibility information in the same request.

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 1/30/2018
Status Date 3/23/2018
Status F - Final
Primary References
Document X12
SectionDTP