Section title: Requests for Interpretation
RFI #
2300
Insurance Type Codes for Duals
Description

For members with dual Medicare and Medicaid coverage, what EB04 qualifier should be used in 2110C/D of the 271?

That is, if a member has Medicare, the EB04 qualifier could be QM & if a member has Medicaid, the EB04 qualifier would be MC. However what if the member has both? Should the Medicare EB04 qualifier such as 'QM' be sent if it is primary? Or, should both be sent in separate EB segments, or maybe only "MP" should be used to indicate Medicare Primary? If MP is used, how would you communicate that the member also has Medicaid coverage?

Response

The Loop 2110C and 2110D EB - SUBSCRIBER ELIGIBILITY OR BENEFIT INFORMATION has a Loop repeat >1.  Therefore, the Loop can be repeated as many times as necessary to report benefit information for one or more Plans.   

DOCUMENT ID
005010X279A1