Dana,
If I were a health plan, I would verify both ISA and 2100B.
The ISA is going to tell you who sent the transaction, which could be the
provider themselves, or it could be a clearinghouse or some other
submitter. You would want to verify that this organization is one you know
and trust. You may know and trust the sender in the ISA, but there could
be transactions at the ST level that the sender is forwarding to you from a
provider you don't know or that you don't take transactions from for
various business reasons. Therefore, you may need to reject a transaction
at this level. This could happen if the sender is a clearinghouse that
services the provider in question, but doesn't know that you may have
discontinued or suspended information exchanges with such provider.
Similarly, you may also need to verify the sender at the GS level.
Don
"Grant, Dana" <[EMAIL PROTECTED]>@wedi.org on 09/13/2001 09:59:59 AM
Please respond to <[EMAIL PROTECTED]>
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To: "'[EMAIL PROTECTED]'" <[EMAIL PROTECTED]>,
"'[EMAIL PROTECTED]'" <[EMAIL PROTECTED]>
cc:
Subject: Verification that receiver of information is authorized
When a payor receives a file, for example a 270 eligibility inquiry, from a
clearinghouse, is the payor required to verify that the information
receiver
is authorized to receive the eligibility response at the ISA segment level
only or is the payor required to verify each receiver at the 2100B loop
level is authorized?
Thanks in advance for your feedback and help.
Dana Grant
Business Analyst/HIPAA-EDI
Coventry Health Care
E-mail: [EMAIL PROTECTED]
Phone: 724-778-3782
Fax: 724-778-4284
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