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Back  RFI # 951: Usage of INS04=25 in 271

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Submitter

Chris Baker

Description

For the 271 response, what constitutes a "change" to the identifying elements...one which would require the information source to send INS03=001 and INS04=25?

Is a change in case (e.g., doe vs DOE) considered a change?

Submitter Assigned Keywords

INS04

Response

004010X092 does not have any explicit requirements to return the INS03=001 and INS04=25 in the event that identifying elements were changed.

Recommendation

005010X279 requires that if any of the information used to identify the subscriber or dependent that was sent in the 270 is changed in a way that would impact a subsequent transaction such as the 837 or 278, then you would need to indicate that a change was made.

If you would reject an 837 or 278 because you received lower case “doe” in that transaction and returned “DOE” in the 271 response, then you would need to use the INS03=001 and INS04=25.

It is recommended that 004010X092 transactions follow the requirements of 005010X279.
Submission 1/27/2010
Status Date 2/26/2010
Status F - Final
Primary References
Document 004010X092A1
Section3.1
Page214
Set ID271
Table2
Loop2100C
Segment Position110
Segment IDINS
Element Position04
Code Value25