We've just begun to look at the problem of describing eyewear devices with LOINC codes. Describing the "eyewear benefit" could be done in many cases by simply returning a list of the most common product configurations that a particular patient is eligible for or by providing Y/N answers to queries about specific configurations. But some Vision plan rules use logic that is not commonly found in health plans and may not be expressible in the 270/271. For example, patient co-payment is a key piece of elig. information and some plans calculate the co-pay for a particular glasses-configuration based on the doctor's U&C fee for a "base" or reference product. I doubt that the 270 provides a way to send the base/reference information, but maybe it does. We are just beginning to collect this information from payors about these unusual business needs and will know a great deal more in a few weeks.
My understanding about "attachments" in general (which may not be legally correct) is that they could be developed for virtually any transaction to convey information that is needed occasionally (and was, therefore left out of the parent transaction standard). Thanks, Chris At 01:27 PM 10/10/01 -0400, [EMAIL PROTECTED] wrote: >Hi Chris, > >No, we have not looked at using the attachment for eligibility inquiries. >This has never been suggested. I'm not convinced at this point it would be >necessary. I would rather see you use the 270/271 structure as it >currently exists and perhaps add LOINC codes if this is the best code set >to use to the list of possible codes for the EQ02 on the inquiry and EB13 >on the response. Attachments were meant to provide medical information, to >show medical necessity or supporting evidence for claim payment or for care >authorizations. I don't think this should now be used to express benefit >information. > >Is there a reason that creating a new code set (similar to HCPCS) for EQ02 >and EB13 will not satisfy your business need to show health plan benefits >and coverage information for vision care? > >Don > > > > > >"Christopher J. Feahr, OD" <[EMAIL PROTECTED]> on 10/10/2001 01:13:27 PM > >To: [EMAIL PROTECTED], [EMAIL PROTECTED] >cc: <[EMAIL PROTECTED]> >Subject: RE: White Paper - Impact on DDE Services > > >Don, >As you may recall from our elig. discussion around vision benefits last >Feb., the primary method for delivering specific eyewear co-pays, coverage >caps, etc. to providers is via (non-standard) DDE services. Since Vision >is now looking very hard at a Claim Attachment Standard as a vehicle for >the non-HCPCS-codable eyewear detail, it may turn out that we will also >require an "eligibility attachment"... if we want a standard, electronic >means of communicating the sort of detail that providers can get today from >proprietary DDEs. The question-answer format of the HL7 attachment >framework would lend itself to the elig. query/response paradigm. For >vision, we will want to key the elig. responses to specific product >configurations that will only be describable by LOINC codes... something >that we cannot currently drop into a 271. What do you think of the idea of >an Eligibility Attachment standard? Has this been discussed? > >Thanks, >Chris > >At 11:56 AM 10/10/01 -0400, [EMAIL PROTECTED] wrote: > > >Stanley, > > > >The question regarding "additional information" came up at our last X12N > >meeting in the Eligibility Work Group. I'm not sure I fully agree with > >your answer. It seems to me, that if additional information is provided >on > >the transaction that would be of value to the provider, then it should >also > >be on the 271 transaction or else it makes the DDE solution more desirable > >to use than the 270/271, which is not permitted by Final Rules for > >Transactions Section 162.925(a)(1-4). > > > >If the 271 transaction can't support the information, then I would suggest > >that this addtional information should be set up as a distinct inquire, > >separate from the eligibility inquiry. If the 271 has a short coming in > >providing necessary information, then the health plan should bring this to > >the attention of the X12N SDO via the DSMO process or they should attend > >the X12N conference and Eligibility Work Group and raise the concern >there. > > > >Don Bechtel > > > > > > > > > > > >"Stanley Nachimson" <[EMAIL PROTECTED]> on 10/09/2001 10:45:52 AM > > > >To: <[EMAIL PROTECTED]>, <[EMAIL PROTECTED]> > >cc: > >Subject: RE: White Paper - Impact on DDE Services > > > > > >There are two questions being discussed here. Regarding the "additional > >information" we have considered that any DDE system can provide additional > >information on additional screens (or using links if it is a Web based > >system). However, providers can not be required to access or accept the > >additional information. > > > >Regarding the need to accept a 270 and respond to a 271, that is a > >requirement of the regulation. A web based DDE system can be offerred as > >an option, but requirment is that the regular EDI 270/271 EDI transaction > >must be supported. > > > >Stanley Nachimson > >Office of Information Services, CMS > >410-786-6153 > > > > >>> "Neumeister, Tammy" <[EMAIL PROTECTED]> 10/09/01 09:40AM >>> > >This question has raised another question at our organization. We are > >considering purchasing a product from our payor software vendor that would > >allow web access to providers for eligibility inquiry, referrals, and >claim > >status inquiries. Is this sufficient to comply with the HIPAA >requirements > >for electronic capabilities for these transactions or must we also be able > >to accept and return an EDI 'batch' transaction for providers? > > > >Tammy Neumeister > >SAS Programmer > >MercyCare Insurance Company > >PO Box 2770 > >Janesville, WI 53547-2770 > >800-752-3431 X 3068 > >Direct 608-758-7725 > >Fax 608-752-3751 > >[EMAIL PROTECTED] > > > > > > > -----Original Message----- > > > From: Karen LaJaunie [SMTP:[EMAIL PROTECTED]] > > > Sent: Monday, October 08, 2001 3:44 PM > > > To: [EMAIL PROTECTED] > > > Subject: White Paper - Impact on DDE Services > > > > > > I have a question regarding the 'Impact on DDE Services' White Paper - > > > 8.15 No Incentives for Using DDE. > > > > > > Is it considered an 'incentive' if more information is returned via a >Web > > > Site transaction than from an EDI Transaction? > > > > > > For example, if a provider inquires about a Member's Eligibility via >our > > > Web Site, our Web Site has the ability to return more information > > > regarding the eligibility of the member than our EDI process which is > > > controlled by a vendor system. Is this considered 'incentive' for the > > > provider to use our Web Site rather than submitting the 270 via EDI? > > > > > > Any input regarding this issue is appreciated. > > > > > > Thanks! > > > > > > > > > > > > Karen L. LaJaunie > > > Senior Project Consultant > > > Blue Cross Blue Shield of Kansas City > > > Phone: (816) 395-2635 > > > Fax: (816) 395-2605 > > > > > > > > > ********************************************************************** > > > To be removed from this list, send a message to: >[EMAIL PROTECTED] > > > Please note that it may take up to 72 hours to process your request. > > > >********************************************************************** > >To be removed from this list, send a message to: [EMAIL PROTECTED] > >Please note that it may take up to 72 hours to process your request. > > > > > > > >********************************************************************** > >To be removed from this list, send a message to: [EMAIL PROTECTED] > >Please note that it may take up to 72 hours to process your request. > > > > > > > > > > > > > > > > > > >------------------------------------------------------------------------------- > > >This message and any included attachments are from Siemens Medical >Solutions > >Health Services Corporation and are intended only for the addressee(s). > >The information contained herein may include trade secrets or privileged >or > >otherwise confidential information. Unauthorized review, forwarding, > >printing, > >copying, distributing, or using such information is strictly prohibited > >and may > >be unlawful. If you received this message in error, or have reason to > >believe > >you are not authorized to receive it, please promptly delete this message >and > >notify the sender by e-mail with a copy to [EMAIL PROTECTED] Thank you > > > >********************************************************************** > >To be removed from this list, send a message to: [EMAIL PROTECTED] > >Please note that it may take up to 72 hours to process your request. > >Christopher J. Feahr, OD >http://visiondatastandard.org >[EMAIL PROTECTED] >Cell/Pager: 707-529-2268 > > > > > > > > >------------------------------------------------------------------------------- >This message and any included attachments are from Siemens Medical Solutions >Health Services Corporation and are intended only for the addressee(s). >The information contained herein may include trade secrets or privileged or >otherwise confidential information. Unauthorized review, forwarding, >printing, >copying, distributing, or using such information is strictly prohibited >and may >be unlawful. If you received this message in error, or have reason to >believe >you are not authorized to receive it, please promptly delete this message and >notify the sender by e-mail with a copy to [EMAIL PROTECTED] Thank you Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268 ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request.
