Eric, I strongly encourage you to submit your situation and question officially to X12 via its RFI portal - http://www.x12.org/x12org/subcommittees/x12rfi.cfm . You are dealing with a federally mandated (read a law) to use the 271 in accordance with the HIPAA-mandated TR3. Rather than guess - and most likely get some interesting recommendations here - getting the official story from X12 will be a good in case the feds decide to truly begin to enforce compliance.
Additionally, it seems you are a health plan - and as such it would be good for you to become conversant with the ACA (health care reform act) Section 1104 Administrative Simplification which in part includes the following: ''(h) COMPLIANCE.- ''(1) HEALTH PLAN CERTIFICATION.- ''(A) ELIGIBILITY FOR A HEALTH PLAN, HEALTH CLAIM STATUS, ELECTRONIC FUNDS TRANSFERS, HEALTH CARE PAYMENT AND REMITTANCE ADVICE.-Not later than December 31, 2013, a health plan shall file a statement with the Secretary, in such form as the Secretary may require, certifying that the data and information systems for such plan are in compliance with any applicable standards (as described under paragraph (7) of section 1171) and associated operating rules (as described under paragraph (9) of such section) for electronic funds transfers, eligibility for a health plan, health claim status, and health care payment and remittance advice, respectively. ''(B) HEALTH CLAIMS OR EQUIVALENT ENCOUNTER INFORMATION, ENROLLMENT AND DISENROLLMENT IN A HEALTH PLAN, HEALTH PLAN PREMIUM PAYMENTS, HEALTH CLAIMS ATTACHMENTS, REFERRAL CERTIFICATION AND AUTHORIZATION.-Not later than December 31, 2015, a health plan shall file a statement with the Secretary, in such form as the Secretary may require, certifying that the data and information systems for such plan are in compliance with any applicable standards and associated operating rules for health claims or equivalent encounter information, enrollment and disenrollment in a health plan, health plan premium payments, health claims attachments, and referral certification and authorization, respectively. A health plan shall provide the same level of documentation to certify compliance with such transactions as is required to certify compliance with the transactions specified in subparagraph (A). ''(2) DOCUMENTATION OF COMPLIANCE.-A health plan shall provide the Secretary, in such form as the Secretary may require, with adequate documentation of compliance with the standards and operating rules described under paragraph (1). A health plan shall not be considered to have provided adequate Rachel Foerster 847-872-8070 From: [email protected] [mailto:[email protected]] On Behalf Of escott001 Sent: Wednesday, August 08, 2012 7:55 AM To: [email protected] Subject: [EDI-L] HIPAA 271 mapping question Hello, I am creating a 271 for dental benefits. The problem I am encountering is that we have 18 different benefit classifications (with potentially different copay %, deductible, maximum, etc.) and there are only 13 service type codes that we can match up for the EB03 value. I am working with the business folks to map the 18 values to the 13 service type codes as accurately as we can; however, it cannot be done without some loss of information. One of our trading partners has suggested that we leave the EB03 values blank and use a MSG segment to supply the benefit class name. From what I can tell, this is allowable but discouraged by the 271 implementation guide. I am curious how others in the industry are addressing this issue. Are you mapping with some information loss? Using free form text in a MSG segment? Something else? Kind regards, Eric [Non-text portions of this message have been removed] ------------------------------------ ... Please use the following Message Identifiers as your subject prefix: <SALES>, <JOBS>, <LIST>, <TECH>, <MISC>, <EVENT>, <OFF-TOPIC> Job postings are welcome, but for job postings or requests for work: <JOBS> IS REQUIRED in the subject line as a prefix.Yahoo! Groups Links <*> To visit your group on the web, go to: http://groups.yahoo.com/group/EDI-L/ <*> Your email settings: Individual Email | Traditional <*> To change settings online go to: http://groups.yahoo.com/group/EDI-L/join (Yahoo! ID required) <*> To change settings via email: [email protected] [email protected] <*> To unsubscribe from this group, send an email to: [email protected] <*> Your use of Yahoo! Groups is subject to: http://docs.yahoo.com/info/terms/
