CAQH CORE Eligibility & Claim Status Operating Rules: CAQH CORE 260: Eligibility & Benefits Data Content (270/271) Rule
The CAQH CORE 154 Rule, which is extended and modified by CAQH CORE 260, requires health plans to provide patient benefit coverage information in response to an X12 270 eligibility inquiry either up to 12 months in the past or up to the end of the current month. Health plans are not required to return remaining deductible for past time periods as it would not be feasible for a health plan to attempt to reconstruct what the remaining deductible may have been for any date in the past. Similarly, it would be not be possible for health plans to project what the remaining deductible could be at a future date.
The CAQH CORE Eligibility & Benefits (270/271) Data Content Rules (154 & 260) do not require support for a date range inquiry. Entities can make individual determinations on whether or not to support this type of inquiry. The CAQH CORE 154 and 260 Rules do require that health plans, vendors, and clearinghouse support X12 270 requests for benefit information at least 12 months into the past and up to the end of the current month. This requirement would include returning benefit information for the current plan period if such a request was received.
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