Bill, The "no incentive" requirement refers to DDE and basically states that a plan can not create an incentive for providers to use DDE over the EDI standard. My interpretation would be that if a plan has a DDE method that supplies more complete information relative to the 270/271 than the response to the EDI 270/271 should also be complete. This does not apply to information disseminated in human to human transactions via the telephone.
Lindsay -----Original Message----- From: Matkovich, Bill Sent: Tuesday, February 12, 2002 5:11 PM To: '[EMAIL PROTECTED]' Subject: RE: 270/271 question No, a telephone call is not an electronic exchange. When I said 'other' I meant other 'electronic transactions' like the X12, (i.e web, DDE). A phone call would not be included in that 'other' because it is not an electronic transaction. Sorry about the poor wording. -----Original Message----- From: Heiert, David [mailto:[EMAIL PROTECTED]] Sent: Tuesday, February 12, 2002 3:53 PM To: '[EMAIL PROTECTED]' Subject: RE: 270/271 question Wait a minute... Is a telephone call electronic data exchange? Is that what is being said here?? Or do the privacy rules apply to telephone conversations.... -----Original Message----- From: Tom Connelly [mailto:[EMAIL PROTECTED]] Sent: Tuesday, February 12, 2002 4:49 PM To: [EMAIL PROTECTED] Subject: RE: 270/271 question If I may, our interpretation, which is based on Don's e-mail, is that you cannot give more information on the phone than that which is available on the corresponding X12 transaction for which the call is for. >>> [EMAIL PROTECTED] 02/12/02 03:11PM >>> A question pertaining to the 'disadvantage the X12 transaction' clause. Does the information that can be obtained in a phone call set the requirements as far as what an X12 transaction needs to accommodate, or is it the level of response set by other 'electronic' transactions? I know that the disincentive clause applies to DDE, but I am not sure if the amount of information answered in a phone call defines what kind of response is required in an X12 transaction. Bill Matkovich Patrice, I respectfully disagree with your statement. The Implementation Guide also says that a health plan should try to eliminate phone calls and provide as much information that is available and appropriate to the question. We did state that if a health plan could only reply with "yes there is coverage" or "No there is not coverage" that they would be compliant, but that was meant as a minimum and was intended to mean if that was all that was necessary for the provider to know or that this is all that a health plan can possibly return. Unfortunately in most cases this will not eliminate phone calls unless the plan is an indemnity type and nothing more is needed. The real test of what should be supplied is stated in the "Transactions and Code Sets" regulations, which say that you can't disadvantage the X12 transactions with other solutions. So, if you have a DDE solution or an Automated Response solution that provides more information, such as co-pay, deductibles, and so on, then that same information must be provided in the 271 response. Don Bechtel Co-chair X12N TG2 WG1: 270/271 Eligibility Transaction "Thaler, Patrice M" <[EMAIL PROTECTED]> on 02/11/2002 10:29:57 AM Please respond to <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> cc: Subject: RE: 270/271 question To be HIPAA compliant the 271 only has to answer yes or no they are eligible. They do not have to give the provider any information on monetary (copay) or procedure (service type) benefits. Read section 1.3.7 about HIPAA compliance. To be X12 syntax compliant you would handle sending percents in the manner described - if the payer is planning to send it to you. Patrice Thaler Allina Health System HIPAA Project Manager -----Original Message----- From: Jensen Wendy [mailto:[EMAIL PROTECTED]] Sent: Friday, February 08, 2002 8:35 PM To: [EMAIL PROTECTED] Subject: 270/271 question My company has HMO co-pays that can be monetary and percents or both. I am getting push back from a third-party eligibility service that the EB08 (Percent) field cannot be used with EB01 = B (co-payment). The IG does not seem to limit it to co-insurance only. We typically use co-insurance only on our indemnity product and co-payments with our HMO Commercial plans. Am I correct in thinking they need to show our percent co-pays -- that it is HIPAA compliant? Thanks, Wendy Jensen This electronic message transmission, including any attachments, contains information from PacifiCare Health Systems Inc. which may be confidential or privileged. The information is intended to be for the use of the individual or entity named above. 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