Section title: Requests for Interpretation
RFI #
2339
Returning HRA amounts on 271
Description

With Health Reimbursement Accounts being owned by Employers as an employee benefit, to be used as a way to offset member costs, used/exhausted prior to health the patient being responsible for their copay, deductible, coinsurance or out of pocket financial. The amount provided is to be used for qualified services. How on a 271 is the best way to advise a provider that funds are available (base, accums) in an HRA and those funds should be used prior to charging the patient for their copay, deductible, coinsurance and/or out of pocket responsibility?
We'd like to know what is the best approach to return on the 271? What value should be sent in EB01 if dollar amounts are sent in EB07? Is it best to send a description of the type of funding arrangement in the MSG segment?

Response

This can be returned, but there is no way to communicate this Health Reimbursement Account description in the 005010 X279 271 without the use of a MSG segment.

RFI Recommendation

Include the remaining Health Reimbursement Account (HRA) balance in the 2110C/D coverage loop for the active insurance plan coverage that the HRA applies to as follows:
EB01 = D
EB03 = 30 (and other applicable Service Type Code(s) included in the plan coverage loop)
EB04 = plan type
EB05 = plan name
EB06 = 29 for remaining
EB07 = amount remaining in HRA
MSG01 = Indicate that the amount communicated is for an Health Reimbursement Account and it’s order of applicability to the collection of patient financial plan responsibility

The recommendation to use a “D” for EB01 is based on the fact that although an HRA is not a traditional “health plan” benefit, it’s a benefit offered by the employer to offset costs of rendered health plan benefits or services. Also, please note: The rules of that guide need to be followed, as such, the minimum requirements for a compliant transaction would apply. This includes those items in section 1.4.7. Section 1.4.7.2 specifically advises that, for each plan for which the member has active or inactive coverage, a 2110C/D loop with an EB01 value equal to 1 through 8 and an EB03 value of 30 along with a plan name if one exists. The HRA information may be returned in addition to the minimum required information as described above.

DOCUMENT ID
005010X279