Stuart, I understand that health plans do not have to support the EQ02 in the response 271. For example, the provider submits a request for benefits for procedure code 99212. The health plan does not support this level of functionality and responds to the provider based on the service type 30-Health Benefit Plan Coverage. Currently, our DDE solution only allows providers to select a service type code from a drop down list. There is no way for the provider to submit a procedure code or EQ02 within the request. My question is must the DDE solution allow for the user to enter in data for EQ02?
Thanks for your help. Dana -----Original Message----- From: Stuart Beaton [mailto:[EMAIL PROTECTED]] Sent: Friday, May 17, 2002 10:32 AM To: Grant, Dana; [EMAIL PROTECTED] Cc: Campese, Mary Frances; Fullmer, Natalie Subject: RE: DDE 270/271 EQ01/EQ02 Dana, The HIPAA transaction rules dictate that for DDE systems they must comply with the data content of the transaction set. The HIPAA transaction rules also state that DDE cannot offer additional functions availible in the transaction set, but not supported by users of the X12 transaction. You are not mandated to support the EQ02 procedure code functionality in the 270 Eligibility transaction, so you would not have to support it through your DDE. Even if you do support the use of EQ02 in the 270 Eligibility transaction, you are not mandated to support it through DDE. In general terms, so long as your DDE system has equal or less functionality (including response time) than those available to providers using the X12 transaction you will be fine. It's when you offer more functionality through DDE than the X12 transaction (including response time) that you will have compliance problems. Stuart Beaton Vice President Washington Publishing Company Co-Chair X12N/TG2/WG1 - Health Care Eligibility -----Original Message----- From: Grant, Dana [mailto:[EMAIL PROTECTED]] Sent: Fri 5/17/2002 9:10 AM To: '[EMAIL PROTECTED]' Cc: Campese, Mary Frances; Fullmer, Natalie Subject: DDE 270/271 EQ01/EQ02 For the 270/271 Health Care Eligibility Benefit Inquiry and Response Transaction set, within the EQ segment in the 270 Inquiry, either EQ01-Service Type Code or EQ02-Composite Medical Procedure Identifier must be used. Only EQ01 or EQ02 is to be sent, not both. Can a health plan's DDE system support only EQ01-Service Type Codes or must it support both EQ01-Service Type Codes and EQ02-Composite Medical Procedure Identifier? I appreciate any feedback that may be provided and would be interested in hearing from other health plans using DDE for the 270/271. Thanks for your time. Dana Grant Business Analyst/HIPAA-EDI Coventry Health Care E-mail: <Mailto:[EMAIL PROTECTED]> Phone: 724-778-3782 Fax: 724-778-4284 Coventry Health Care has a new look on the internet! Visit http://www.coventryhealth.com
