271 Premium Payment Grace Period Notification 7030 Related Issues
271 Premium Payment Grace Period Notification EDI transaction can indicate that a patient that was the subject of a health care
eligibility is currently in a grace period. The important usage regulations are given in our previous posts. This blog post refers to 271 Premium Payment Grace Period Notification EDI transaction additional and related issues.
The following business terms are used in 271 Premium Payment Grace Period Notification operation.
Enrollee: The primary person in a relationship with a health plan for health insurance. This may be an individual with direct coverage with the health plan, or an individual with coverage through their employer or other sponsoring entity. The individual may be acting for him
or her self alone (individual coverage), or also acting for their dependents. In other electronic data interchange transactions, the terms subscriber and insured are generally equivalent to the term enrollee. When related to an HIX enrollment, the term is defined as in 45 CFR 155.20, which currently states “Enrollee means a qualified individual or qualified employee enrolled in a QHP“.
Grace Period: A period of time during which an enrollee may reinstate an insurance product after a missed premium payment without a break in coverage or benefits.
Premium Payment: Transfer of funds by an enrollee or sponsor to a health plan to cover the cost of health insurance for a specific period.
The purpose of transaction acknowledgments is to report to the sender whether the transaction being acknowledged was accepted or rejected. The ASC X12 Technical Report Type 2, Acknowledgment Reference Model provides guidance on several control structures and transaction set standards intended to augment EDI auditing and control systems.
Three transactions that are related also can convey information about a patient being in a premium payment grace period. They are:
- Health Care Claim Payment/Advice (835)
- Health Care Claim Status Response (277)
- Health Care Eligibility Benefit Response (271)
Five transactions that are related initiate an action that can result in one of the above three transactions:
- Health Care Claim – Dental (837)
- Health Care Claim – Institutional (837)
- Health Care Claim – Professional (837)
- Health Care Claim Status Request (276)
- Health Care Eligibility and Benefit Inquiry (270).