Alex, For something misidentified in this manner, you would have to make your own determination as to what response you would give back...but, again, I would think that if given the information provided on the inbound 270 you can be certain you've identified the correct individual in your system, why not return a meaningful answer. After all, the intent here is to avoid requiring the provider to make a phone call.
In any case, it's still a business decision as to what you want to do in the scenario you describe. Rachel -----Original Message----- From: Alex Chernyak [mailto:[EMAIL PROTECTED]] Sent: Monday, April 29, 2002 10:30 AM To: [EMAIL PROTECTED] Subject: RE: Subscriber vs. Dependent And how about when the provider marks the subscriber as a patient (2100D) but submits the details for a dependent (2200E) or vice versa? >>> "Rachel Foerster" <[EMAIL PROTECTED]> 04/25/02 09:15PM >>> Jonathan, I'm sure/hope others here will also respond, but here's my take on your questions: 1. If the patient is NOT the subscriber, the patient HL should be created, even in the absence of knowing the member id for the patient. If the patient is the subscriber, then ONLY the subscriber HL should be created with as much identifying information as can be obtained, keeping in mind the minimum data required for subscriber/patient identification. 2. If the information source can accurately and unequivocally ascertain that the individual being queried about is the same individual in their system, I would recommend responding even if the individual is not the subscriber, but putting the individual's information in the appropriate HL structure. Of course, in both cases, you'd have to determine your own business rules for these responses, since the implications could be different if the query was for eligibility versus authorization/referral. Rachel Rachel Foerster Principal Rachel Foerster & Associates, Ltd. Professionals in EDI & Electronic Commerce 39432 North Avenue Beach Park, IL 60099 Phone: 847-872-8070 Fax: 847-872-6860 http://www.rfa-edi.com -----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. ---------------------------------------------------------------------------- -- CONFIDENTIALITY NOTICE: This message is intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential or exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that you are strictly prohibited from printing, storing, disseminating, distributing or copying this communication. If you have received this communication in error, please notify us immediately by replying to the message and deleting it from your computer. Thank You, Antares Management Solutions. ============================================================================ ==
