Jon,
Your system should always expect to recieve multiple EBs. Using Service
Type Code = 30 allows the provider to ask for Health Benefit Plan Coverage
and the health plan can respond as they feel appropriate. The instructions
to the payer are to answer the question as fully as possible in order to
eliminate phone calls. This might mean that the plan will provide all
coverages provided under the plan, or they may look at the provider type
and setting and answer as appropriate.
Using Service Type Code = 60 allows the provider to ask for General
Benefits. Again, the health plan is free to respond with as much
information as they feel is relevant and to which their system is capable
of responding. This might be a simple yes/no there is coverage, but again
the health plans are instructed to provide as much information as they can
to eliminate unnecessary phone calls. So, they might respond with there are
Medical Care benefits for office visits (well and sick), Hospital benefits,
Vision benefits, Dental benefits, etc., and again they might taylor their
response based on the provider type asking the question and the setting.
Don Bechtel
"Jonathan Fox" <[EMAIL PROTECTED]>@wedi.org on 09/06/2001 09:50:53
AM
Please respond to <[EMAIL PROTECTED]>
Sent by: [EMAIL PROTECTED]
To: <[EMAIL PROTECTED]>
cc:
Subject: 270/271
My organization is testing with the 270/271 transaction set. Below are
some questions we have:
1.) When you submit a service type of "30" in the 270/EQ01 segment, is it
correct to receive several EB segments in the 271 that list all benefits
the subscriber has? Or should you just receive 1 EB segment?
The standards lists a service type of "30" as Health Benefit Plan Coverage.
2.) What if you submitted a service type of "60" in the 270/EQ01 segment.
What would you expect to receive in the 271/EB? Again would you receive 1
EB segment, or would you receive several EB segments in your 271 response?
The standards lists a service type of "60" as General Benefits.
Thanks in advance for your responses.
Jon Fox
eCommerce Analyst
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