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Back  RFI # 2300: Insurance Type Code for Duals

Formal vs. Informal Help Informal Formal

Submitter

Kenneth Greenspan

Description

For members with dual Medicare and Medicaid coverage, what EB04 qualifier should be used in 2110C/D of the 271?

That is, if a member has Medicare, the EB04 qualifier could be QM & if a member has Medicaid, the EB04 qualifier would be MC. However what if the member has both? Should the Medicare EB04 qualifier such as 'QM' be sent if it is primary? Or, should both be sent in separate EB segments, or maybe only "MP" should be used to indicate Medicare Primary? If MP is used, how would you communicate that the member also has Medicaid coverage?

Submitter Assigned Keywords

Dual Medicare Medicaid EB04

Response

The Loop 2110C SUBSCRIBER or 2110D DEPENDENT EB (ELIGIBILITY OR BENEFIT INFORMATION) has a Loop repeat >1. Therefore, the Loop can be repeated as many times as necessary to report benefit information for one or more Plans.
Submission 6/19/2018
Status Date 8/10/2018
Status F - Final
Primary References
Document 005010X279A1
Section2
Page299
Set ID271
Table2
Loop2110C
Segment Position1336
Segment IDEB
Element Position04
Industry NameInsurance Type Code