7030 271 Premium Payment Grace Period Notification: Implementation Purpose and Scope
7030 271 Premium Payment Grace Period Notification implementation guides refer to parties who to send and/or receive electronic grace period information in a standardized transaction. For the health care industry to achieve the potential administrative cost savings with Electronic Data Interchange (EDI), standards have been developed to facilitate consistent implementation by all organizations. To facilitate a smooth transition into the EDI environment, uniform implementation is critical. The purpose of the series of 7030 271 Premium Payment Grace Period Notification blog posts is to provide standardized data requirements and content for the users of the Eligibility, Coverage or Benefit Information (271) for reporting Health Insurance Exchange (HIX) Premium Payment Grace Period, other (non-HIX) premium payment grace periods, and related information from health plans to providers.
The Affordable Care Act and related Federal and state regulations created HIXs and require the provision of a premium payment grace period (grace period) to enrollees that have received advance payments of the premium tax credit and have previously paid at least one full month’s premium during the benefit year. Notification of persons in the second and third month of the grace period to impacted providers is required.
Details of the Federal regulations and requirements are specified in 45 CFR 156.270(d)(2), Notifications to HHS, and 45 CFR 156.270(d)(3), Notifications to Providers, and in accordance with the provisions of Chapter 5, Section 7.ii, Notice of Pending Claims— to Providers, of the CMS Letter to Issuers for 2014
This blog post will assist those who wish to send and/or receive electronic grace period information using a standardized transaction. Entities sending the transaction are health plans, insurance companies, third party administrators, and their business associates. All of these entities are referred to as health plans in our series of 7030 271 Premium Payment Grace Period Notification blog posts. Entities receiving the transaction include, but are not limited to, hospitals, nursing homes, laboratories, physicians, dentists, allied health professional groups, and their business associates.