One point of clarification - your statement "The 271 response must also be returned as quickly as the one returned on the DDE system (once again there cannot be an incentive to receive a faster response on DDE over the standard transaction)."
HHS has been asked to confirm that response time is indeed considered an incentive. As far as I am aware of, they have not yet confirmed this. At this point this is an interpretation of incentive, it is not implicitly stated in the regulations.
Kris Owens
Senior IS Project Manager - HIPAA Project
Presbyterian Healthcare Services
Albuquerque, NM
505.923.8108
[EMAIL PROTECTED]
"There is no meaning in isolation"
-----Original Message-----
From: Stuart Beaton [mailto:[EMAIL PROTECTED]]
Sent: Friday, May 31, 2002 5:02 PM
To: David Frenkel; [EMAIL PROTECTED]
Subject: RE: Internet Transaction limitations?
There are a few things to bear in mind about DDE, internet or not, vs 270/271 (or any mandated transaction for that matter). If the health plan offers DDE, they must also support their 270/271 to the same level as the DDE system, so long as there is a place for the information in the 270/271. Not supporting the standard transaction to the same level as on DDE would be considered an incentive to use DDE over the standard transaction. 45 CFR Parts 160 and 162 (the transaction final rule) states:
"162.925(a)(4) A health plan may not offer an incentive for a health care provider to conduct a transaction covered by this part as a transaction described under the exception provided for in 162.923(b).
"162.923(b) Exception for direct data entry transactions. A health care provider electing to use direct data entry offered by a health plan to conduct a transaction for which a standard has been adopted under this part must use the applicable data content and data condition requirements of the standard when conducting the transaction. The health care provider is not required to use the format requirements of the standard."
For instance, if the DDE system can identify that the subscriber has a $10 copay for a physician office visit, they must return this information in the 271 (EB*B**98****10~). If the DDE system identifies the subscriber's Primary Care Physician, so must the 271 (EB*L~LS*2120~NM1*P3*1*JONES*MARCUS***MD*SV*111223333~). Most of the information that could be displayed on a DDE system would be able to be returned in the 271 transaction.
The 271 response must also be returned as quickly as the one returned on the DDE system (once again there cannot be an incentive to receive a faster response on DDE over the standard transaction).
Offering an elaborate DDE system and supporting the "Yes/No" minimal response on the 271 mentioned below would not be a compliant solution.
Stuart Beaton
Vice President
Washington Publishing Company
Co-Chair X12N/TG2/WG1 - Health Care Eligibility
[EMAIL PROTECTED]
-----Original Message-----
From: David Frenkel [mailto:[EMAIL PROTECTED]]
Sent: Thu 5/30/2002 12:53 PM
To: [EMAIL PROTECTED]
Cc:
Subject: RE: Internet Transaction limitations?
Larry,
You are correct but you might ask the healthplans you may work with if
they can support anything beyond 'yes' or 'no' for eligibility on the
270/271. A yes or no response is the minimum requirement for the
270/271.
Regards,
David Frenkel
Business Development
GEFEG USA
Global Leader in Ecommerce Tools
www.gefeg.com
425-260-5030
-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]
Sent: Thursday, May 30, 2002 9:22 AM
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: Re: Internet Transaction limitations?
Is it also true, that even if a healthplan supports a DDE type of
eligibility
system that they must ALSO support a 270/271 if that transaction is
requested
by any of their providers?
Larry A. Saltzman, MD
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