When responding to STC 47 on a 270/271 eligibility request, is appropriate to return an active coverage indicator only with a comment referring providers to the individual STCs for the sub-components (i.e., STCs 48-53) for detailed coverage information?
From a configuration perspective, it seems to be cumbersome and confusing to a provider to try to list all of the cost-sharing information for all hospital related services on the single response to STC 47. Given there are sub-components for hospital coverage that could more appropriately return cost-sharing specific to the services in question, we are wondering if it would be appropriate to configure the response in the manner described in the question or if the expectation is to return all of the cost-sharing information for all hospital benefits when responding to STC 47.
In version 005010X279A1, if the information source wants to return on the 271 service type codes 48-53 in response to a service type code 47 on the 270 inquiry, it’s up to their discretion. There is no requirement in the currently mandated TR3 to support the granular service type codes on either the request or the response.
It’s highly recommended that the submitter of this RFI refer to other mandated requirements, such as the mandated operating rules for additional service type code support expectations.