Kris,
X12N has many more transactions and Implementation Guides than those that are mandated
for use under HIPAA. Any willing trading partners can use X12N Implementation Guides
(or proprietary formats for that matter) for any business event not covered under
HIPAA. Unsolicited Eligibility and Benefit Roster transactions fall into this
category. It is generally used as a one way transaction from payer to provider to
identify which members are assigned to PCPs and their associated benefits in an HMO
environment. Typically these transactions are sent on a monthly basis.
It is possible in the future that the Secretary of HHS may name this transaction as a
standard transaction under HIPAA, but at this point it is up to trading partners to
define what format they will use (if any) for this business function.
I hope this helps clarify things for you,
Stuart Beaton
Vice President
Washington Publishing Company
Co-Chair X12N/TG2/WG1 - Health Care Eligibility
-----Original Message-----
From: Owens, Kris [mailto:[EMAIL PROTECTED]]
Sent: Mon 4/15/2002 3:03 PM
To: '[EMAIL PROTECTED]'
Cc: Recalde, Jose (Tony)
Subject: RE: 271 Unsolicited
Help my organization be clear the issue of the 271 Unsolicited roster.
The regulations mandate the 270/271 request/response pair, not the unsolicited
roster
Subpart L—Eligibility for a Health Plan
§ 162.1201 Eligibility for a health plan transaction.
The eligibility for a health plan transaction is the transmission of either of
the following:
(a) An inquiry from a health care provider to a health plan, or from one
health plan to another health plan, to obtain any of the following information about a
benefit plan for an enrollee:
(1) Eligibility to receive health care under the health plan.
(2) Coverage of health care under the health plan.
(3) Benefits associated with the benefit plan.
(b) A response from a health plan to a health care provider’s (or another
health plan’s) inquiry described in paragraph (a) of this section.
§ 162.1202 Standards for eligibility for a health plan.The Secretary adopts
the following standards for the eligibility for a health plan transaction:
... (b) Dental, professional, and institutional. The ASC X12N 270/271–
Health Care Eligibility Benefit Inquiry and Response, Version 4010, May 2000,
Washington Publishing Company, 004010X092. The implementation specification is
available at the addresses specified in § 162.920(a)(1).
So.... am I correct in assuming that even if the 271 Roster is finalized, the
HIPAA standards for transactions will still have to be revised to require the roster
as a mandated standard? (Not that using the 271 roster isn't a good idea...)
In other words, once the guide has passed the final proofing phase and is
published does not infer a change in the mandated transactions? Are we interpreting
this correctly?
thanks,
Kris Owens
Senior IS Project Manager - HIPAA Project
505.923.8108
[EMAIL PROTECTED]
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