Would it ever be correct for an information source (payer) to return a 271 eligibility response transaction with Loop 2110C DTP01 = "346" (Plan Begin) and DTP02 = "RD8" (Range of Dates)? The code description seems to imply a single date, but technically the specification appears to allow a range of dates for any code. Is there a valid scenario where a single plan could "begin" across a range of multiple dates? Or is it ever valid to use code "346" for both start and end dates?
We are examining a payer's 270/271 EDI companion guide and suspect that it might contain an error. The guide states as follows:
"The eligibility response will populate Loop 2110C/D – EB03 valued with 30 - DTP01 with ‘346’ to represent the health plan coverage start and end dates. When only one date is sent in the response, the date represents the member’s eligibility start date; DTP02 will be valued with ‘D8.’ When DTP02 value of ‘RD8’ is sent, then both a start date and end date will be returned indicating coverage has ended."
While the DTP01 values are not necessarily restrictive of what can be sent in DTP02 and to some degree, what is sent in DTP03, the situational rule in the 2100C/D states that the only time the code value ‘346’ is allowed to be sent is when the individual has active coverage. Thus, an end date would not be valid in a DTP segment with DTP01 = 346 and DTP02 = RD8. The information source must meet the specifications identified in the situational rule to be allowed to send the 2100C/D DTP segment in the 271 as the situational rule states that the DTP must not be sent if the situational rule is not met.
Required when the individual has active coverage with multiple plans or multiple plan periods apply (See 2100C DTP segment);
OR
Required when needed to convey dates associated with the eligibility or benefits being identified in the 2110C loop.If not required by this implementation guide, do not send.
While the TR3 does not prohibit using the DTP01 value ‘346’ and sending a range of dates qualifier ‘RD8,’ where the date is the same in DTP03 date range positions, this approach is not recommended, nor preferred.