Leah, A trading partner agreement (TPA) would resolve the issue of what the expectations are of trading partners in regards to what is sent and received. An issue I have seen numerous times is that additional data is sent to a trading partner and these changes are not communicated.
Regards, David Frenkel Business Development GEFEG USA Global Leader in Ecommerce Tools 425-260-5030 -----Original Message----- From: Leah Hole-Curry [mailto:[EMAIL PROTECTED]] Sent: Tuesday, June 25, 2002 9:14 AM To: [EMAIL PROTECTED] Subject: RE: an inquiry for a non-existing member The official comments to transactions standard at page 50340 support that a response would be required to a 270, and any transaction for which the health plan has applicable information: Comment: "One commenter suggested that we clarify the requirements to clearly state that while health plans must implements the 270/271 Eligibility request/response, they are not required to respons to all requests sent in the 270." Response: "We do not agree. A health plan may not reject a standard transaction because it contains information the health plan does not want. This principal applies to the data elements of all transactions in this rule. Health plans must accept a complete 270 and must respond with all applicable responses that are included in the 271..." Leah Hole-Curry FOX Systems, Inc. 602.708.1045 Information transmitted is confidential and may be proprietary to FOX Systems, Inc. It is intended only for the person or entity to which it is addressed. Anyone else is prohibited from disclosing, copying, or disseminating the contents or attachments. If you receive this in error, please notify sender immediately, or us at www.foxsys.com and delete from your system. >>> [EMAIL PROTECTED] 06/25/02 08:38 AM >>> Alex, My opinion is that yes, a 271/277 response is required for a 270/276 inquiry either providing the answer(s) to the question posed or indicating why it is not possible to answer specifically. Just think of the analogy of a phone call....if your call center person can't respond to the specific question being asked by the caller, what do they do/how do they respond? I'm sure they don't just hang up the phone! Rachel -----Original Message----- From: Alex Chernyak [mailto:[EMAIL PROTECTED]] Sent: Tuesday, June 25, 2002 10:25 AM To: [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: RE: an inquiry for a non-existing member Rachel, Is it mandatory to respond (271 or 277) when a member is not found on the membership system? Like status code 33 for 277 - subscriber & subscriber id not found.... thanks ------------------------------------------------------------------------ ---- -- 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. 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