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Back  RFI # 320: Uses of the 270/271

Formal vs. Informal Help Informal Formal

Submitter

barbara jones

Description

We have a company requesting to send us the name and SSN in the subscriber loop of the 270 batch transaction. If this person is the insured and has insurance return all the dependents (in the dependent loop) under the subscriber in the 271. Note these are segments that did not come in on 270. Is the 270/271 transaction set up to do this? If it is, how will we know when to do this and when not to? Is there a certain qualifier or segment that would tell us?

Response

The decision to support this type of request/response is at the option of the Information Source (Health Plan).

The proper way to request the entire family be returned in the 271 is by placing FAM in 2110C EQ03 of the 270. But, just because a 270 request contains EQ03 = FAM, doesn't mean the health plan will return the entire family in the response especially now that HIPAA Privacy is in place. The issue outside of the guide is whether that would be permissible under HIPAA privacy and that would have to be up to the health plan to determine. The guide itself supports it.

Alternately, you can return FAM in 2110C EB02 indicating there is Family coverage associated with the subscriber but not return the dependents. Again this is at the option of the health plan.
Submission 9/7/2005
Status Date 11/1/2005
Status F - Final
Primary References
Document 04010x092A1
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