7030 271 Premium Payment Grace Period Notification: Business Usage
7030 271 Premium Payment Grace Period Notification transaction is intended to meet the particular needs of the health care industry for the reporting of premium payment grace period information from a health plan to a provider. While usage may differ in frequency, this transaction is designed to operate in three ways:
- Created by health plans on a periodic (for example – monthly) basis and sent to or made available to providers, as an unsolicited mode. The transaction only contains information about patients in a grace period when the health plan has determined that the provider is impacted by the patient’s grace period. The transaction supports identification that there are no enrollees within a grace period by identification of the health plan and provider, without inclusion of any patients.
- Created by health plans on demand based upon health plan receipt of eligibility and benefit request(s) or claim(s) related to a patient currently in a grace period.
- Created as a notification that a patient previously identified as within a grace period in a notification, or through another mechanism (for example, eligibility and benefit information, claim status, or remittance advice) has paid their premium and is no longer in the grace period.
Within the Health Insurance Exchange (HIX) regulations, the term “issuer” is used to identify the insurance company that is issuing the Qualified Health Plan. External to HIXs, the term “health plan” is generally used to identify the health plan, or insurance company. Anytime usage or requirements apply only to the more regulated HIX environment, the term “issuer” will be used.
There are federal requirements for issuers regarding HIX grace period notification. These include five different categories of statements: statement of the purpose of the notification:
- explanation of the grace period
- statement of consequences of grace period exhaustion for the patient
- statement of consequence of grace period exhaustion for the provider
- statement of provider options
These statements are not carried in this transaction since this information is relatively static and is not patient or provider specific. The information required is carried by reference to a location on the health plan’s website that contains the detailed statements and explanation. The PER segment in the 2100A loop or 2100C, Health Plan Grace Period URL, identifies the URL where the information can be viewed when located on the health plan’s website.