Dana,
No, you do not have to support it on DDE. As I mentioned below, since you do not
support a 270 EQ02 request, you do not have to support it on DDE. You are using the
default response on your 271 since you are not able to respond to an EQ02 request.
That would parralel your support of the EQ01 service type codes. In fact, were you to
add the capability of entering a procedure code to your DDE system, it could imply
that you can support an EQ02 inquiry.
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 10:43 AM
To: Stuart Beaton; '[EMAIL PROTECTED]'
Cc: Campese, Mary Frances; Fullmer, Natalie
Subject: RE: DDE 270/271 EQ01/EQ02
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
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