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Back  RFI # 971: 5010 271 Minimum Response

Formal vs. Informal Help Informal Formal

Submitter

Boyle-Campbell Donna

Description

A member has 3 different coverages for health, dental and vision, each with a different group number but a single subscriber ID that applies to all plans. The 270 inquiry contains the subscriber ID, DOB, maybe the name and an EQ01=30.

When the Information Source returns the 271, in addition to items 1-6 of 1.4.7.1, is it expected that the information source at a minimum must return the 3 different plans above -health, dental and vision, as well as whatever else is part of the member's plan or is a covered benefit required per 1.4.7.1, item 8?

Submitter Assigned Keywords

Minimum Response

Response

This issue is explicitly addressed in guide 005010X279. For a request as described, all of the requirements identified in ection 1.4.7.1 must be met. This includes item 8. When all information for a series of service type codes is identical, then the repeating feature must be used to consolidate those codes.

The situational rule for the REF segment that would contain the Group Code reads like "Required when an additional identifier is associated with the eligibility or benefits being identified in the 2110C loop." Since there are three Group codes involved and the Group Codes are associated with the eligibility or benefit information, that means that the Group Code information must be supplied. That also means that the health related, dental and vision eligibility and benefit information must be sent in separate 2110 loops (versus using repeating Service Type Codes in a single loop) because the Group Code information differs for the various Service Type Codes.
Submission 2/22/2010
Status Date 6/15/2010
Status F - Final
Primary References
Document 005010X279
Section1.4.7.1
Page20
Set ID271