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Back  RFI # 2271: Returning Multiple Subscribers

Formal vs. Informal Help Informal Formal

Submitter

Jonathan Fox

Description

Recently, a trading partner submitted an issue to our helpdesk complaining that our 271 Response was not properly formatted because it contains multiple 2000C Loops. They cited RFI’s 1651 and 1785 as supporting evidence of their concern.
I would like to respectfully request a review of the aforementioned RFI’s for accuracy and request an amendment based on the following additional information. RFI 1651 references the authors’ intent to limit Real-time interactions to single requests. We suggest that section 1.3.2, paragraph 3 mediates that restriction to allow multiple responses.
I would also refer you to the following pages of the guide for rebuttal of your RFI 1785:
Page 18, Section 1.4.7 - paragraph 3
Furthermore:
Referencing Section 1.4.8.7 (below) – the recommendation is to return a AAA, which is in direct conflict with the guidance provided in RFI 1785.
(Note: additional reference to specific guide text can be provided upon request).

Response

The 00510X271A1 TR3 explicitly states that multiple 2000C or 2000D Loops are not allowed when the transaction set is used in a Real Time mode. This is also specifically addressed in RFI #1785.

Section 1.4.3 (Real Time) reads in part:

“It is required that the 270 transaction contain only one patient request when using the transaction in a real time mode (See the Exceeding The Number of Patient Requests section below for the exception). One patient is defined as either, one subscriber loop if the member is the patient, or one dependent loop if the dependent is the patient (See Section 1.4.2 Patient for additional information). The 271 response can only contain eligibility and benefit information for the patient(s) identified in the 270 request unless the 270 request contained a value of "FAM" in 2110C EQ03 and this level of functionality is supported by the Information Source.”

Regarding section 1.4.8.7, the guidance provided in RFI #1785 addresses the scenario where more than one set of plan benefits is identified with the same member ID when a primary search option was used.
Submission 2/28/2018
Status Date 5/4/2018
Status F - Final
Primary References
Document 005010X279
Section1.4
Page18
Set ID271
Table2
Loop2000C