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Back  RFI # 923: 271 X279 Other Payer reqt

Formal vs. Informal Help Informal Formal

Submitter

joanne hoagland

Description

In the front matter of the 270/271 5010X279 (page 19/20), "Minimum Requirements for IG Compliance" indicates that Other Payer or Plan, if known, must be returned in the 2120C/D loop of the 271. As a payer, we need to understand if the expectation is that this other payer information must be returned if it is not validated first. We capture other payer information from a variety of sources, and store that information in a comments area within our systems. Other payer information is not the only data that is stored in that comments area. Because of the requirement to return Other Payer information, we could be returning all kinds of information from that comments area. We are concerned about the accuracy of this information, and the fact that it has not been validated and may not always actually be Other Payer information. Your interpretation/opinion is appreciated.

Submitter Assigned Keywords

Other Payer Information

Response

If a health plan has knowledge of the existence of another health plan and that knowledge will impact the adjudication of the claim, then that other plan must be identified in the 271 response.

If a health plan knows that additional payers exist that may not impact adjudication (such as a secondary payer), that information must also be returned.
Submission 12/14/2009
Status Date 2/26/2010
Status F - Final
Primary References
Document 005010X279
Section1.4.7.1
Page19
Set ID271