7030 271 Premium Payment Grace Period Notification (Part 3)

7030 271 Premium Payment Grace Period Notification: Usage Basis

7030 271 Premium Payment Grace Period Notification EDI 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. 7030 271 Premium Payment Grace Period Notification electronic document can be used in four ways:

1. A periodic transaction (e.g. established by regulation or contract) can indicate that there are no patients within the grace period known to impact a provider. This is accomplished by sending Health Plan and Provider information without any patient information.This is an original notification, and can be identified by BHT02 = “14” (Advance Notification), and the absence of the Enrollee and Dependent hierarchical levels.
2. A periodic transaction can indicate that there are patients within the grace period impacting the provider. This is accomplished by sending Health Plan, Provider and Enrollee information, and dependent information if appropriate for any specific enrollee. This is an original notification, and can be identified by BHT02 = “14” (Advance Notification), and the presence of the Enrollee hierarchical level.
3. The transaction can indicate the removal of one or more patients (and any related dependents) from a grace period due to payment of the related premium. This optional use would occur after a prior notification of patients in the grace period either through a notification transaction, eligibility and benefit response, claim status or remittance advice. Removal is accomplished by sending Health Plan, Provider and Enrollee Information, and Dependent information if appropriate for a specific enrollee. This is a change notification, and can be identified by BHT02 = “SU” (Status Update).
4. A transaction can indicate that a patient that was the subject of a health care eligibility and benefit check or claim is currently in a grace period.This is an original notification, and can be identified by BHT02 = “06” (Confirmation).