Jan,
* How are other payers handling this requirement?
A: We search our member records for a match. Our member records are
date driven so we can try to match the inquiry date with a period of
time that the member had coverage. Our benefits history is then pulled
for that member and a 271 is built.
* Will providers submit routine requests for benefits based on
dates other than current (except for Medicaid)?
A: Our providers submit past, present and future inquiries.
* Will we be out of compliance if we return benefits for current
dates on an explicit response?
A: Yes, but more importantly you're returning (possibly) inaccurate
data.
Implementation Guide, Section1.3.7 page 20,
"An information source must respond with either an acknowledgment that
the
individual has active or inactive coverage or that the individual was
not
found in their system. The response will be for the date the
transaction is
processed, unless a specific date (prior, current or future) was used
for
the DTP of the EQ loop, (prior dates are needed for Medicaid
inquiries...).
* Does this imply prior dates are applicable to Medicaid only?
A: No. Prior dates are applicable for everyone.
Same section, last paragraph, page 21 states "The information source
is
required to at least respond with the minimum compliant response ("Yes,
the patient is eligible today" or "No, the patient is not eligible
today").
* Meaning, when we return a '30', we do not have to look at the DTP
segments?
A: A '30' means that you can't address specific inquiries, so you
respond with the level of information that you can...but it should be
date sensitive.
Hope this helps.
Jon Fox
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.
>>> [EMAIL PROTECTED] 09/16/02 02:49PM >>>
We are a payer with questions regarding the benefits component of the
270/271 in regards to dates submitted in the 270 when returning a
robust,
explicit response. The IG states that we have to look at prior,
current
(blank), or future dates in the DTP segment of loops 2100C or D or
2110C or
D. We are doing this for eligibility but it would be very difficult
to
quote benefits on prior and future dates. To do so would require us
to
create difficult logic to read our service codes, calcs and schedules.
* How are other payers handling this requirement?
* Will providers submit routine requests for benefits based on
dates
other than current (except for Medicaid)?
* Will we be out of compliance if we return benefits for current
dates
on an explicit response?
Implementation Guide, Section1.3.7 page 20,
"An information source must respond with either an acknowledgment that
the
individual has active or inactive coverage or that the individual was
not
found in their system. The response will be for the date the
transaction is
processed, unless a specific date (prior, current or future) was used
for
the DTP of the EQ loop, (prior dates are needed for Medicaid
inquiries...).
* Does this imply prior dates are applicable to Medicaid only?
Same section, last paragraph, page 21 states "The information source
is
required to at least respond with the minimum compliant response ("Yes,
the
patient is eligible today" or "No, the patient is not eligible today").
* Meaning, when we return a '30', we do not have to look at the
DTP
segments?
Thank you!
Jan Murphy-Hole
Sr. Business Analyst
Great-West Life & Annuity
EBIS-HIPAA
303-737-3439
email: [EMAIL PROTECTED]
**********************************************************************
To be removed from this list, send a message to: [EMAIL PROTECTED]
Please note that it may take up to 72 hours to process your request.
======================================================
The WEDI SNIP listserv to which you are subscribed is not moderated.
The
discussions on this listserv therefore represent the views of the
individual
participants, and do not necessarily represent the views of the WEDI
Board of
Directors nor WEDI SNIP. If you wish to receive an official opinion,
post
your question to the WEDI SNIP Issues Database at
http://snip.wedi.org/tracking/.
Posting of advertisements or other commercial use of this listserv is
specifically prohibited.
**********************************************************************
To be removed from this list, send a message to: [EMAIL PROTECTED]
Please note that it may take up to 72 hours to process your request.
======================================================
The WEDI SNIP listserv to which you are subscribed is not moderated. The
discussions on this listserv therefore represent the views of the individual
participants, and do not necessarily represent the views of the WEDI Board of
Directors nor WEDI SNIP. If you wish to receive an official opinion, post
your question to the WEDI SNIP Issues Database at
http://snip.wedi.org/tracking/.
Posting of advertisements or other commercial use of this listserv is
specifically prohibited.
