Section title: Requests for Interpretation
RFI #
886
Definitions of DTP codes
Description

In Loops 2100C, 2100D, 2110C, and 2110D the DTP01 segments have multiple codes with similar descriptions. Are there standard definitions for these descriptions? As the state of Minnesota builds its companion guide and best practices we want to remain consistent with the National standards.

Here are the codes we would specifically like to understand the differences. Are any of these recommended to be used by Information Sources in the 271 response?

291 Plan

307 Eligibility

346 Plan Begin

347 Plan End

348 Benefit Begin

349 Benefit End

356 Eligibility Begin

357 Eligibility End

539 Policy Effective

540 Policy Expiration

Response

Instructions for the correct use of codes 291 (Plan), 346 (Plan Begin), 292 (Benefit) and 348 (Benefit Begin) are included in Section 1.4.7.1 Item 1. This same section includes the following:

“NOTE: Plan dates represent coverage dates in the plan or program that is being represented in the response. This date does not have to represent the historical beginning of eligibility for the plan, only the most recent plan date(s). For example, Medicaid may only report plan dates in one month periods of time.”

Definitions do not exist for the other DTP01 Date Time Qualifiers, however in many cases the Date Time Qualifier itself should be descriptive enough for most purposes (e.g. Policy Expiration). Where definitions do not currently exist for these codes, only X12 can add definitions to these codes through the X12 Standards and TR3 process.

RFI Recommendation

The 005010X279 TR3 contains instructions and requirements for the proper use of the Plan and Benefit date codes in order have the industry consistently use those codes as the primary method of communicating coverage dates to a provider.

Codes associated with other dates should only be used in addition to Plan and Benefit dates when it is important to relay these additional dates to the provider. In most cases, use of other date codes is not advised as they are rarely of benefit and may cause confusion to the recipient as to the true status of coverage for the individual. For example, it is not important to know that a person was eligible for Medicare on their 65th Birthday, what is important to know is when their plan coverage actually began, which is relayed using DTP01 = 346 (Plan Begin).

DOCUMENT ID
005010X279