Health plans can respond with the information they feel is appropriate to the inquiry, following the rules of required and situational data as defined in the Implementation Guide. Health Plans at this time are not being required to support diagnosis related inquiries, if that is beyond their capabilities. However, Health Plans are encouraged to provide as much information as they can related to the question, with the objective being to eliminate the phone call. So, if a Health Plan knows that they will need to answer questions to a certain level of detail on the phone, they should provide the same level of information in their 271 response.
"Sood, Rajiv" <[EMAIL PROTECTED]> on 01/30/2002 01:56:23 PM Please respond to <[EMAIL PROTECTED]> To: "'[EMAIL PROTECTED]'" <[EMAIL PROTECTED]> cc: Subject: questions on 270/271 Good Afternoon, I would like to ask a few questions regarding the 270/271: 1. In the 270/271 arena, what is the definition of "free-standing" (code 89) (EQ01) (page 93 for 270 and 301 for the 271). 2. How could plans handle providing 3-tier pharmacy benefit information ? 3. If the 271 minimum response is a simple "yes/no" the person is (or is not) eligible, and a plan decides to provide more information (i.e., a true 271), is this an all or nothing proposition ? i.e., if the plan decides to provide a true 271, must all the "required" and "situational" info be provided or is there some choice if a plans systems cannot support inquiries by certain criteria (like diagnosis for example). Thanks Rajiv Thank you, Rajiv Sood, MBA HIPAA Implementation Manager Oxford Health Plans 48 Monroe Turnpike, Trumbull CT 06611 External Phone: 1-203-459-6913 Internal Phone: 8-204-6913 Fax: 1-203-459-6464 Email: [EMAIL PROTECTED] Toll Free: 1-800-889-7658 Ext. 6913 ********************************************************************** 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.
