How should a payer send multiple Class of Contract Code values in a 271 for a single patient who has multiple health plans? A similar question was answered in RFI #1785 for Group Number; however, I do not think the same solution will work for Class of Contract Code. Normally the Class of Contract Code is sent in a Loop 2100C (Subscriber Name) REF (Subscriber Additional Information) segment with REF01 = "CE." As per Section 1.4.7.1 and RFI #2181, the payer is only allowed to send a single repetition of Loop 2100C and must include the benefits for all plans in multiple repetitions of Loop 2110C. The subscriber additional information data that is particular to specific plans must be sent in REF segments in Loop 2110C rather than 2100C. The problem is that the REF01 "CE" qualifier is only allowed at the Loop 2100C level, and it would be a violation to send it at the Loop 2110C level. So, there does not seem to be a way to send multiple Class of Contract Code values and have them tied to the correct plans. They cannot even send both Class of Contract Code values in Loop 2100C, because the TR3 note for that REF segment only allows one occurrence of each REF01 code value.
In principle, the same general question can also arise with other REF01 and DTP01 qualifiers, which are allowed at the Loop 2100C/D level but not allowed at the Loop 2110C/D level.
A payer (information source) is sending a real-time 271 response for a single subscriber who has two active health plans (for example, a Medicare Advantage plan and a Medicaid HMO plan) with the same member ID, and they want to include different Class of Contract Code values for both plans in order to ensure the provider has those available when submitting subsequent claims.
Unfortunately, in 005010X279A1, no way exists to send more than one Class of Contract Code on the 271, outside of using the MSG segment. Generally, the same ID will not exist for both a Medicaid and Medicare member, and the class of contract returned should align only to the product, for that member’s given “type” of coverage.
With that, if the provider wants to know additional information about “other” coverage, as per Section 1.4.7.1 item 6, they should initiate a 270 to the “other” payer to get the class of contract code applicable to that payer’s coverage.