Regarding the Member ID, it probably depends upon which transaction set you're talking about.
To answer your question directly, I can't imagine that it would ever be acceptable to put the Dependent information at the Subscriber level. Looking at the 270, the NM1 segment at the Dependent Level doesn't allow any member ID, so if the patient is a dependent, there's no problem. Just put in what you know. The 276 allows for a Member ID at the Dependent level, but it's (sort of) situational. Should be no (major) problem there, either. As far as having the dependent information at the Subscriber Level, if we receive a transaction in which that is the case, then we would respond with "Entity not found," and specify the Subscriber as the entity. We'll specifically be looking for a Subscriber with the information provided. Since we (probably) won't find one, we'll respond accordingly. Hal Scoggins SBPA Systems, Inc. (281) 679-7272 x116 -----Original Message----- From: Jonathan Fox [mailto:[EMAIL PROTECTED]] Sent: Thursday, April 25, 2002 5:13 PM To: [EMAIL PROTECTED] Subject: Subscriber vs. Dependent I have a question regarding the X12 transaction sets named under HIPAA that use the subscriber and dependent HL structure. More specifically the inquiry/response transactions. If the information receiver (provider) does not know the patient's member id, how should they build the transaction set? Should they put the patient information at the subscriber or the dependent level? Likewise, if the inquiry comes in at the subscriber level, and the member is NOT the subscriber, should we respond? Any guidance would be greatly appreciated!!! Jonathan Fox eCommerce Analyst Independent Health CONFIDENTIALITY NOTICE. This e-mail and attachments, if any, may contain confidential information which is privileged and protected from disclosure by Federal and State confidentiality laws, rules or regulations. This e-mail and attachments, if any, are intended for the designated addressee only . If you are not the designated addressee, you are hereby notified that any disclosure, copying, or distribution of this e-mail and its attachments, if any, may be unlawful and may subject you to legal consequences. If you have received this e-mail and attachments in error, please contact Independent Health immediately at (716) 631-3001 and delete the e-mail and its attachments from your computer. Thank you for your attention.
