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Back  RFI # 523: Providing Correct Member - 271

Formal vs. Informal Help Informal Formal

Submitter

joanne hoagland

Description

Is it possible to return a 271 response to inform the submitter that they have placed the member at the incorrect loop? Horizon BCBSNJ would like to be able to return a 271 response back to our submitter with benefits, but also inform them that they have the relationship incorrect. Is this possible? Thank you.

Response

The 271 2000C Subscriber Level does not require that the subscriber provided be identical to the subscriber from the 270 transaction. The tie back to the submitted 270 request is the trace number in the TRN segment. The intent is that the 271 provide the correct information that is related to the patient involved and the eligibility information being provided. If that means that the patient that was in the 270 as a dependent gets returned as a subscriber, or the other way around, that is appropriate.

If the individual is a dependent and the relationship code is needed for subsequent transactions, such as the 837 Claim or 278 Request for Review, the relationship code should be returned in the 2100D INS01.

Recommendation

To indicate that you have made a change to how the individual is identified, you may also return an INS segment with INS03 = "001" (Change) and INS04 = "25" (Change in Identifying Elements).
Submission 2/26/2007
Status Date 5/7/2007
Status F - Final
Primary References
Document 004010X092A1
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