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Back  RFI # 647: Return Req Date in 2100C Loop

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Submitter

Julianne Mui

Description

Is it allowable to return a 307 (Eligibility) in the 2100C level with a DTP containing the requested date of service that was sent on the 270? We currently do this today to help the provider keep track of the request date that was sent in the 270 and return it in the 271. The note on page 284, situational rule #2 in the 5010 IG, seems to allow this. In reference to page 19 in the 5010 x279 front matter (Section 1.4.7.1). Item #1 indicates the "346 Plan Begin date must be returned in the 2100C/D DTP unless multiple plans apply...", since Medicare will always have multiple plans (Part A/B), we would be sending both Part A & B at the 2110C level and not the 2100C level.

Submitter Assigned Keywords

2100C DTP

Response

NOTE: This response only applies to the version 005010X279 Implementation Guide.

No, it is not allowable to return a 307 (Eligibility) in the 2100C level with a DTP containing the requested date of service that was sent on the 270.

Section 1.4.7.1 requires Information sources to return either the Plan Begin Date (DTP01 = 346) or the range of Plan Dates (DTP01 = 291). The Plan Date(s) to be returned are to be the dates in effect for the Plan Date(s) from the 270 request. The actual date from the request is not to be returned. Absence of a Plan Date in the 270 request implies that the request is for the date the transaction is processed. The dates are to be returned in the 2100C/2100D DTP unless multiple plans exist when the dates are to be returned in the 2110C/2110D DTP.

Recommendation

In the 5010 version of the Implementation Guide, there is no longer a date of service or even a concept of a date of service. The only allowable value as a trigger date for the request in the 270 is DTP01 = 291 (Plan).

You cannot arbitrarily convert a Plan Date (291) from the 270 request to an Eligibility Date (307) to be returned in the 271, they are not the same thing. Further, sending the date from the request would likely contradict the patient’s actual Eligibility dates.

The 270/271 transaction contains TRN segments at the 2000C and 2000D level to enable the Information Receiver to identify the unique request should they need to retrieve the date from their own request.
Submission 4/24/2008
Status Date 6/17/2008
Status F - Final
Primary References
Document 005010X279
Section1.4.7.1
Page19
Set ID271
Table2
Loop2100C
Segment Position1200
Segment IDDTP
Element Position03