Section title: Requests for Interpretation
RFI #
2251
270 Card issue date req'd
Description

I am seeing a requirement for a card issue date in an eligibility inquiry companion guide for a payer. I see the requirement listed in the 270 2100C loop in a situational rule that references 1.4.8 but I do not see anything about this being a requirement in 1.4.8 or the Required Alternate Search Option. Is this something that a payer may require?

RFI Response

The 005010X279A1 270 2100C Loop DTP - SUBSCRIBER DATE segment Situational Rule reads: “Required when the information receiver wishes to convey the plan date(s) for the subscriber in relation to the eligibility/benefit inquiry. If not required by this implementation guide, may be sent at the sender's discretion but cannot be required by the information source. OR Required when utilizing a search option other than either the Primary Search Option or a Required Alternate Search Option identified in section 1.4.8 which requires the ID Card Issue Date. If not required by this implementation guide, may be sent at the sender's discretion but cannot be required by the information source.” An Information Source (payer) cannot require any additional data elements as a part of the Required Primary Search Option (such as Card Issue Date). Payers can offer additional search options (such as one that utilizes the Card Issue Date), however they must support the Required Primary Search Option and the Required Alternate Search Options as written. If the payer offers a search option in addition to the Primary Search Option and Required Alternate Search Options identified in section 1.4.8, the payer may require additional data elements to use in its search. If this additional search option requires the ID Card Issue Date, then the second condition of the Situational Rule has been met and that makes the SUBSCRIBER DATE segment required if the submitter of the 270 wishes to take advantage of that additional search option. Requirements for additional search options are communicated to the submitter either by a Trading Partner Agreement or other means.

DOCUMENT ID
005010X279A1