Balance Billing Protection Act usage of X12 271 Transaction (5010 version)

"Pending adoption of final rules by the Office of the Insurance  Commissioner”

The Balance Billing Protection Act requires that health care providers have a way to determine whether a patient's heath insurance plan is subject to the requirement of the Act.

The below instructions describe the usage of the X12 5010 version of the 271 Eligibility and Benefits Response Transaction to implement section 7(4) of the Balance Billing Protection Act (Chapter 427, Laws of 2019), to communicate that a patient's health insurance plan is subject to the requirements of the Act. As of 10-21-2019, these instructions are "Pending adoption of final rules by the Office of the Insurance Commissioner".

The message to be placed in the 271 transaction is:

"Services provided to this patient are subject to the Balance Billing Protection Act. Please see RCW 48.49.020 for details."

The placement of the message within the 271 transaction is as follows:

a. In an existing:

  • Loop 2110C - SUBSCRIBER ELIGIBILITY OR BENEFIT INFORMATION,  OR
  • Loop 2110D - DEPENDENT ELIGIBILITY OR BENEFIT INFORMATION

b. For the EB segment where EB01=1,2,3,4,5,6,7,8 (active or inactive coverage)

    Place the message in the MSG segment

      Example:

         EB*1*IND*30*PR*THIS IS THE PLAN NAME~

         MSG* Services provided to this patient are subject to the Balance Billing Protection Act. Please see RCW 48.49.020 for details~

Note to providers - there is a limit of 10 messages per each 2110 Loop. If this messages causes the health plan to have more than 10 messages, a separate Loop for the message may be created.