Stuart, I have a side question about coding "vision" type benefits. The "AM Frames" and "AO Lenses" seem to represent specific sub-types of "vision" or "AL" benefits. Am I to assume that "AN Routine Exam" refers to a routine *eye* exam? Or is "routine" generally used throughout healthcare insurance to mean "not medically necessary"... and that "AN" could be used with any type of "routine" service benefit? If so, what is the difference from "AQ"? (Again, is AQ referring to an eye exam or to any "general physical" or "check-up" service?)
If AM, AN, AO, and AQ are all sub-types of "AL", there should probably be a couple more sub-types: for "medically necessary contact lens" and "cosmetic/elective contact lens" benefits. Finally, I was wondering how "BR Eye" would be different from AL... but it might be a non-issue because it seems unlikely that anyone's eligibility system has benefits grouped with this code? From the guide: AL Vision (Optometry) AM Frames AN Routine Exam AO Lenses AQ Nonmedically Necessary Physical BR Eye Thanks, Chris At 01:42 PM 4/24/02 -0700, Stuart Beaton wrote: >Ryan, > >For the 270/271 Health Care Eligibility and Benefit Inquiry and Response >transaction set, you would use the Service Type Code in 2110 EB03. For >Dental you would use either 35 - Dental Care or 41 - Routine (Preventive) >Dental (there are a few more specialized dental categories as well), for >Vision you would use AL - Vision, and for Pharmacy you would use 88 - >Pharmacy. The insurance type code in EB04 identifies the type of plan >(e.g. indemnity, HMO) but not what type of benefits it covers. > >Since there is a codified way to portray this information, you are >prohibited by the Implementation Guide itself from passing that >information in EB05 or in a MSG segment. > >Hope this helps, > >Stuart Beaton >Vice President >Washington Publishing Company >Co-chair X12N/TG2/WG1 - Health Care Eligibility >[EMAIL PROTECTED] > > -----Original Message----- > From: Bradford, Ryan D [mailto:[EMAIL PROTECTED]] > Sent: Wed 4/24/2002 2:26 PM > To: [EMAIL PROTECTED] > Cc: '[EMAIL PROTECTED]' > Subject: Insurance Type Codes > > > We are a little confused with the Insurance Type codes provided > in the Implementation guides. The codes do not cover such types as > Dental, Vision, or Pharmacy. We are using the code OT for Other to show > these Insurance Types. Are there more codes available than what are in > the Guides? > > At this point in time, we are almost ready to implement the > 270/271 transaction. Would we be able to display a code OT for Other in > the EB04 segment, and populate the EB05 segment with text (Vision, > Dental, Pharmacy). Is this compliant? Thanks. > > > > Ryan Bradford > EDS - REVS Provider Services > 155 Federal Street, Floor 6 > Boston, MA 02110 > > * phone: 617-350-8073 > * fax: +01-617-350-8180 > * mailto:[EMAIL PROTECTED] > > Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268
