I have been struggling with similar issues. Is it appropriate for Trading Partners to define an Implementation Guide between themselves, such that a sender of a 270 would expect certain data to be returned in a 271 when the 270 makes a specific request such as FAM - Family? A typical transmission could look like this:
Request ST*270*1~ BHT*0022*13~ HL*1**20*1~ NM1*PR*2*THEPAYER*****PI*XXXXX~ HL*2*1*21*1~ NM1*1P*2*THEPROVIDER*****FI*123456789~ HL*3*2*22*0~ NM1*IL*1*INSURED*KIM****MI*111111111~ DMG*D8*19471225*M~ EQ*98**FAM~ SE*11*1~ Response ST*271*1~ BHT*0022*13~ HL*1**20*1~ NM1*PR*2*THEPAYER*****PI*XXXXX~ HL*2*1*21*1~ NM1*1P*2*THEPROVIDER*****FI*123456789~ HL*3*2*22*1~ NM1*IL*1*INSURED*KIM****MI*111111111~ N3*101 WASHINGTON STREET~ N4*INDIANAPOLIS*IN*46230~ DMG*D8*19471225*M~ INS*Y*18~ DTP*539*D8*20011001~ EB*1~ EB*A*FAM******20****Y~ EB*A*FAM******30****N~ EB*B*FAM*98***27*15*****Y~ EB*B*FAM*98***27*30*****N~ EB*C*FAM****23*3000*****Y~ EB*C*FAM****23*6000*****N~ EB*C*FAM****24*1250*****Y~ EB*C*FAM****24*40*****N~ EB*C*IND****24*125*****Y~ EB*C*IND****24*0*****N~ HL*4*5*19*0~ NM1*03*1*INSURED*WILL~ DMG*D8*19970727*M~ INS*N*19~ DTP*539*D8*20011001~ EB*C*IND****24*1125*****Y~ EB*C*IND****24*40*****N~ SE*32*1~ Is this acceptable? Robert L. Huffman RealMed Corporation -----Original Message----- From: Siegfried, Victoria [mailto:[EMAIL PROTECTED]] Sent: Wednesday, October 17, 2001 8:27 AM To: '[EMAIL PROTECTED]'; '[EMAIL PROTECTED]' Subject: 270/271 Question on EB segments Our health plans would like to send back a 271 with more than the minimally necessary "Yes, the patient is an eligible member today." If a 270 Health Care Eligibility Benefit Inquiry is requesting copay and deductible amounts for a single service type or procedure code, is it acceptable for the payor to return multiple EB segments with in-plan copay, out-of-plan copay, in-plan deductible, out-of-plan deductible, etc.? I would like to hear if other managed care plans are determining whether in-plan or out-of-plan apply upon receiving a 270 request or if all possible benefits are sent in a 271. Also how do providers feel about receiving 8 to 48 EB segments for a member inquiry. Thank you for your help. Vicki Siegfried Business Consultant Coventry Health Care HIPAA / EDI Team (724) 778-5931 ********************************************************************** 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.
