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Back  RFI # 918: 270 5010 DTP Segment Use

Formal vs. Informal Help Informal Formal

Submitter

Nancy Fouche

Description

We currently have 2 potential interpretations on the use of the DTP segment in the 270 when the PLAN date is sent:
1. The PLAN date is the actually eligibility date for the insurance coverage. For example, I became enrolled under CIGNA on July 1, 2005.
OR
2. The PLAN date reflects the date(s) of service for the specific encounter/admission.
With the 4010, we are sending the ‘Date of Service’ or admission date (sending specific date ranges, too). But with the 5010, one of the power point pieces from the July Conference seems to indicate that the PLAN is not the enrollment date, but the ‘date of service’ for the encounter.
What is X12's interpretation of this requirement?"

Submitter Assigned Keywords

270 DTP

Response

Neither of the 2 potential interpretations identified are correct.

The date or dates sent in the 270 indicate that the requestor wants to know what plan is in effect for the date or dates identified in the 2100C/D DTP when DTP01 = 291. This may or may not coincidentally be the date of service or admission, and it is not intended to relay a date of service or admission to the health plan.

Unlike 4010, the plan dates returned in the 005010X279 271 response will not be the explicit dates from the 270. The dates returned must be the Plan Begin date for the plan in effect for the date from the request. 5010 271 responses require Plan dates be returned, not the explicit dates from the request. See section 1.4.7.1 271 requirement 1 and 10 for additional details.

NOTE: A requestor is not required to send any 2100C/D date at all, and in the absence of a date, the date for the request will be the date the transaction is processed.

Recommendation

The concepts of Eligibility Date, Admission Date or Date of Service have been removed from the 005010X279.
Submission 12/4/2009
Status Date 2/26/2010
Status F - Final
Primary References
Document 005010x279
Section?
Page?
Set ID?
Loop2100C
Segment PositionDTP02
Segment IDDTP