HIPAA 7030 271 transaction is divided into five major areas – one header, and four detail hierarchical levels.
The header area identifies the transaction type and implementation, as well as the transaction date and the business purpose of the specific transaction.
- ST03 identifies the Technical Report version and number that identify this as a Premium Payment Grace Period Notification (007030X344)
- BHT01 identifies the hierarchical structure of the transaction using code “0012” (Information Source, Information Receiver, Subscriber, Dependent)
- BHT02 identifies the specific function of the transaction. Code “14” (Advance Notification) indicates that this is an unsolicited original periodic notification containing a listing of members whose enrollment is in the grace period. Code “SU” (Status Update) indicates that this is an update of a prior original transaction, and contains a listing of members whose premium has been brought current since the last original or update transaction. Code “06” (Confirmation) indicates that this is a solicited notification after an eligibility and benefit check or claim submission by the provider.
Detail Level 1 – Health Plan Level – Information Source (2000A)
This level is required and identifies the health plan as the Information Source. The 2100A loop provides information including:
- Health Plan Name
- Health Plan Identifier (HPID or proprietary identifier)
- Health Plan Address
- Health Plan Premium Payment Grace Period Information URL
- Health Plan’s Provider customer service telephone number
- Report Date – the date that the information was reported out of the Health Plan’s business system
Detail Level 2 – Provider Level – Information Receiver (2000B)
This level is required and identifies the specific provider that is receiving the grace period notification as an impacted provider. This is usually the institution or group practice, and is only a specific individual when the provider is not incorporated or working for another organization. Information conveyed includes:
- Impacted provider name
- Impacted provider ID (NPI, proprietary ID, or Tax ID, whichever is applicable or mandated)
- Impacted provider address
- Impacted provider city, state and ZIP Code.