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Back  RFI # 257: 2110C & D containing EQ

Formal vs. Informal Help Informal Formal

Submitter

mark keitel

Description

The 2110C loop of the 270 transaction says to use the loop when the subscriber is the patient and not when the subscriber is not the patient. In a situation where a subscriber and a dependent are both patients and the subject of an eligibility check, is it permissible per this guide to send a 2000C loop with a 2110C inside and a question for the subscriber followed immediately by a 2000D loop with the dependent and the dependent's 2110D loop, or must a second 2000C loop without a 2110C be sent as the parent of the 2000D loop to identify the subscriber of the dependent?

In other words, which structure is permitted by the guide:

1) 2000C(Jane Doe)/2110C/2000D(Johnny Doe)/2110D

2) 2000C(Jane Doe)/2110C/2000C(Jane Doe)/2000D(Johnny Doe)/2110D

Please assume that this is either a batch transaction or a realtime transaction where the payer will accept more than 1 patient per 270 transaction.

Thank you.

Submitter Assigned Keywords

EQ Loops for Subscriber and Dependent

Response

Yes, it is permissible per the 004010X092/004010X092A1 Imp. Guide/ Addenda to have 2110 EQ loops present in both the Subscriber (2100C) and Dependent (2100D) loops for the same Subscriber when both the Subscriber and Dependent(s) are patients in a batch transaction. Multiple patient requests can also be supported in a Real Time as outlined in Section 1.3.3 “Although it is not recommended, if the number of patients is to be greater than one for real time mode…, the trading partners (the Information Source, the Information Receiver and the switch the transaction is routed through, if there is one involved) must all agree to exceed the number of recommended patient requests and agree to a reasonable limit.”

Pg 89 Note 2 states “Use the EQ loop/segment when the subscriber is the patient whose eligibility or benefits are being verified. When the subscriber is not the patient, this loop must not be used.”

Pg 108 Note 1 states “Use the Dependent Level only if the patient is a dependent of a Member”.

Recommendation

Clarifying notes and examples have been added to later versions of the Implementation Guide indicating that this is allowable.

“In a batch mode, it is possible to have patient requests in both the subscriber and dependent levels (e.g. subscriber and spouse).”

Information Source (Loop 2000A)
Information Receiver (Loop 2000B)
Subscriber (Loop 2000C)
Eligibility or Benefit Inquiry
Subscriber (Loop 2000C)
Eligibility or Benefit Inquiry
Dependent (Loop 2000D)
Eligibility or Benefit Inquiry
Submission 5/24/2005
Status Date 9/16/2005
Status F - Final
Primary References
Document 004010X092A1
Section030
Page71
Set ID270
Loop2110C
Segment Position030
Segment IDEQ