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Back  RFI # 683: Deductible Dates

Formal vs. Informal Help Informal Formal

Submitter

Leonard Mallard

Description

Version 004010X092A1 of the implementation guide (270/271) provides for payer (information source) responses to coinsurance, copay, and deductible information (EB01 = A, B, or C). Is it the intent of the authors to indicate to information receivers the date(s) that deductibles were met by the insured using DTP03 with a specific qualifer in DTP01?

Submitter Assigned Keywords

Date Deductible Met

Response

The 004010X092A1 does not require a payer to return any specific information relating to the deductible, co-insurance, co-payment or of the other values related to the other patient's portion of financial responsibility.

The health plan has the ability to return the base deductible amount, the amount remaining for the deductible as well as the date the amount remaining was zero (which would indicate the deductible was met).

Recommendation

As has always been a recommendation, the more information that a health plan can return, the better for both the health plan and provider in avoiding an unnecessary telephone call to retrieve relevant information that can be systematically returned in the 271 response.

To explicitly indicate the initial deductible amount for the year and then that the deductible has been met on a specific date, the response would look something like this:

EB*C******500~
DTP*292*RD8*20080101-20081231~
EB*C*****29*0~
DTP*198*D8*20080704~

If providing an intermediary state where there is still a deductible remaining and the date that amount was last updated, the second EB loop would look something like this:

EB*C*****29*200~
DTP*636*D8*20080704~
Submission 9/4/2008
Status Date 11/21/2008
Status F - Final
Primary References
Document 004010X092
Section1251
Page241
Set ID271