Work Group 1 - Eligibility and Benefits

  • 9 Nov 2018 6:29 AM
    Reply # 6896365 on 6895652
    Tiarra Earls (Administrator)
    Kevin Moore wrote:

    In the task group breakout at the UIF, we decided to look again for a way to send the fee schedule ID when the plan has a schedule of allowances. We discovered the 7030 adds a code for this. in the 271 transaction, loop 2110D, the REF segment has some new codes that can be sent, and one of those is AFT - fee schedule identifier.


    Thanks, Kevin. I'll take note. 

    Best, 

  • 8 Nov 2018 2:46 PM
    Reply # 6895652 on 6420887
    Anonymous

    In the task group breakout at the UIF, we decided to look again for a way to send the fee schedule ID when the plan has a schedule of allowances. We discovered the 7030 adds a code for this. in the 271 transaction, loop 2110D, the REF segment has some new codes that can be sent, and one of those is AFT - fee schedule identifier.

  • 11 Oct 2018 5:54 PM
    Reply # 6718846 on 6420887
    Anonymous

    Regarding benefit year dates/plan coverage dates

    In version 5010, 271 loop 2110C, the DTP segment is for subscriber dates. In the v5010 TR3, 291 is defined as “Plan”. Delta Dental understands DTP*291 to be the benefit year start and end dates. Example:

    DTP*291*RD8*20180101-20181231~

    In the v5010 TR3, section 1.4.7.1 had minimal instruction on these. In version 7030, the instructions are in 1.4.8.2.1.2 of the TR3 and they go a little further in explaining when to use 346 versus 291. The wording is confusing to me, because they say “plan coverage dates”, which to me mixes the concepts of “plan” and “coverage” together. To me, “coverage” means eligibility (eligibility is communicated using qualifier codes 356 and 357). I think my issue is merely with the wording. I believe in v7030 we will continue to send DTP*291 as in the above example. (Though in v7030 we will send these in the 2105C loop instead of 2110C.) Does anyone disagree?
     

  • 11 Oct 2018 10:10 AM
    Reply # 6718152 on 6420887
    Anonymous

    Regarding Contract ID:

    In the 7030 phone call, I couldn’t remember where in the 270 or 271 v5010 the was a “contract ID” which is being removed in v7030. Here is is: in the v5010, in the 270, loop2100B, Information Receiver Name, under the REF segment, one of the possible values in REF01 is CT for contract number. It is also in 270 loop 2100C and 2100D and 271 loops 2100B, 2100C, and 2100D. If you go into these same loops in v7030, you will not find CT as a valid value in REF01.

     

  • 7 Aug 2018 10:19 AM
    Message # 6420887
    Tiarra Earls (Administrator)

    Through a consensus building process, this work group is responsible for advancing the growth and adoption of electronic eligibility benefit inquiries submitted via the ANSI ASC X12 270/271 transactions.

    Chair: Leah Blakeman, Project Manager, Insurance Operations, Aspen Dental Management, Inc.

    Monthly Meeting: Second Thursday of each month 11:00 am AZ time 


    Last modified: 7 Aug 2018 10:20 AM | Tiarra Earls (Administrator)
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