Change Request Detail
No.
1144
Date
2/4/2011
Submitter
Type of Request
Pertaining to more than one, or not sure
Status
DSMO Process Completed
Business Reason
There is a need for a provider to receive plan administrator information, designated by the sponsor, in a 271 Health Care Eligibility Benefit Response.
Suggestion
Add in the 834 Benefit Enrollment and Maintenance transaction a 1000D Plan administrator information to be passed from the Sponsor to the Payer.

The addition of this information will help the provider automate the administrative functions associated with the provision of medical care and getting paid. This information can then be supplied to the provider in the 271 Health Care Eligibility Benefit Response transaction in the 2120C and 2120D loops.
DSMO Category
D
Recommendation
Disapprove. The DSMO supports the concept of the request, however, until the HPID regulation is finalized, no final definitive decisions can be made on the request as submitted. until Third Party Administrator and Plan Sponsor are understood in the context of the HPID regulation, the request cannot be definitively evaluated.

Appeal Recommendation