RFI Browser

Back  RFI # 847: 271, N3 - SUBSCRIBER ADDRESS

Formal vs. Informal Help Informal Formal

Submitter

karthik Subramanian

Description

Some Blue Plans are interpreting the Subscriber ID Address to be required on the 271 Eligibility Response when the Subscriber is the Patient. Can you tell me what is the intent of the the address field and if it is always required on the 271 when the Sub is the patient?

TR3, Situational Note:
Required when the Subscriber is the patient or when the Information
Source requires this information to identify the Subscriber for subsequent
EDI transactions (see Section 1.4.7), but not required if a rejection
response is generated and this segment was not sent in the request. If not
required by this implementation guide, may be provided at sender’s
discretion but cannot be required by the receiver.

Thanks in advance

karthik

Response

This issue is explicitly addressed in guide 005010X279. The Rule on the 271 loop 2100C N3 segment reads "Required when the Subscriber is the patient or when the Information Source requires this information to identify the Subscriber for subsequent EDI transactions (see Section 1.4.7), but not required if a rejection response is generated and this segment was not sent in the request. If not required by this implementation guide, may be provided at sender’s discretion but cannot be required by the receiver."

Therefore, the Subscriber N3 segment is required whenever the subscriber is the patient except when the following also apply:

1 - the response is a rejection,

and

2 - the request 270 did not include the 2100C loop N3 segment.

This requirement ensures that all Health Plans return all information needed to process subsequent HIPAA transactions, such as the 278 or 837.

See section 1.4.7.1 and the 5010 837 TR3s for additional information on this data requirement.

Recommendation

Submission 8/31/2009
Status Date 9/3/2009
Status F - Final
Primary References
Document 005010X279
SectionN3
Page257
Set ID271