Wednesday, 14 May 2014

271–5010 Health Care Eligibility Benefit Response - Subscriber Demographic Information and Subscriber Date –Loop 2100C


Subscriber Demographic Information.

Loop Seg ID Segment Name Format Length Ref# Req Value
2100C DMG Demographic Information ID 3 S DMG
Element Separator AN 1 *
DMG01 Date Time Period format Qualifier ID 2 1250 S D8 = Date format
Element Separator AN 1 *
DMG02 Date Time Period AN 8 1251 S <CCYYMMDD - Recipient Date of Birth>
Segment Terminator ~



Loop Seg ID Segment Name Format Length Ref# Req Value
2100C DTP Subscriber Date ID 3 R DTP
Element Separator AN 1 *
DTP01 Date Time Qualifier ID 2 374 R See values below
Element Separator AN 1 *
DTP02 Date Time Period Format Qualifier ID 2/3 1250 R D8 or RD8
Segment Terminator ~

DTP 01 – Date Time Qualifier
Code Definition
096 Discharge
102 Issue
152 Effective Date of Change
291 Plan
307 Eligibility
340 Consolidated Omnibus Budget Reconciliation Act (COBRA) Begin
341 Consolidated Omnibus Budget Reconciliation Act (COBRA) End
342 Premium Paid to Date Begin
343 Premium Paid to Date End
346 Plan Begin
347 Plan End
356 Eligibility Begin
357 Eligibility End
382 Enrolment
435 Admission
442 Date of Death
458 Certification
472 Service
539 Policy Effective
540 Policy Expiration
636 Date of Last Update
771 Status

DTP 02 – Date Time Period Qualifier

Code Definition
D8 Date Expressed in Format CCYYMMDD
RD8 Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD




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