HIPAA 7030 271 Transaction: Detail Levels 3-4
HIPAA 7030 271 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. Find info about Header and Detail Levels 1-2 in the previous blog post.
Detail Level 3 – Enrollee (2000C)
The enrollee level is situational and identifies the individual enrollee(s) whose premium payment status is being conveyed. This level is not used when the transaction is a periodic report identifying that there are no active premium payment grace periods that impact the provider identified in the related Information Receiver level.
When this level is present in a periodic transaction (BHT02=”14″), these are enrollees that are currently in the premium payment grace period that may impact the provider identified in the related Information Receiver loop. When the transaction is a status update (BHT02=”SU”), this level identifies enrollees that had previously been reported as in the grace period who have subsequently made payments that removed them from the grace period.
Information conveyed in this level includes:
- Enrollee name
- Enrollee identifier with the health plan
- Enrollee date of birth
- Enrollee address
- Enrollee city, state and ZIP Code
- Enrollee Country Code
- Enrollee phone number
- Related Qualified Health Plan (QHP)
- Qualified Health Plan Name
- Qualified Health Plan ID
- Grace Period Type
- Premium Paid Through Date
- Trace number identifying this notification
When the transaction is a notification (BHT02=”14″ or “06”) the following additional information is included:
- First Day of the related premium payment grace period
- Last Day of the related premium payment grace period
- Identifier of the applicable current premium payment grace period month or time period (as dictated by regulation)
When the transaction is a status update (BHT02=”SU”), indicating the payment of premium by the enrollee, the following information is also present: Premium Paid Indicator.
Detail Level 4 – Dependent (2000D)
The dependent level is situational and identifies dependents of enrollees that are related to a enrollee’s coverage. They are impacted by the enrollee’s failure to make the premium payment, or subsequent payment to resolve the grace period. This level is only populated when the applicable enrollee has enrolled in coverage for more than a single person.
Information conveyed in this level includes:
- Dependent name
- Dependent Identifier (if assigned)
- Dependent address (when different than the related enrollee information)
- Dependent city, state, ZIP Code (when different than the related enrollee information)
- Dependent Country Code (when different than the related enrollee information)
- Dependent date of birth.