A live person on the phone is not limited to what can be provided in a
271 response or a 277 or any other HIPAA required response.  Talking to
a person on the phone is not considered the use of "electronic media",
as defined by 162.103.  Direct Data Entry, which is the subject of the
limitation to which you are referring, cannot have incentives for its
use (See 196.925(4)).  A prohibition on incentives for other modes of
electronic media communications are what is intended, not limiting
the usefulness of picking up a phone and trying to get a situation
resolved by speaking to a live person.  

 

>>> "Schmidt, Lee M" <[EMAIL PROTECTED]> 03/05/03 04:26PM
>>>
Assuming the inquiry was through a phone call and that the HMO &Client
were
covered entities, the phone rep should provide the same level of
benefit
information made available through the 271 response and any HMO
eligibility
web applications to which the provider has access.  

In short, there can be no incentive for the provider to use one mode
of
inquiry over another which means all avenues of disseminating
eligibility
information must provide the same level of detail.

Understand that the 271 does provide comprehensive benefit information,
but
at this time the government regulates that the minimum response to an
eligibility inquiry is a yes/no. 

Thanks,
 
Lee M. Schmidt
Magellan Behavioral Health
HIPAA / I.T. Project Manager, Claims Applications 
Local: (314) 387-5445 
Toll Free (St. Louis): 1-800-450-7281 ext: 75445  
New Cell: (314) 960-0964 
Fax: 314-387-5655 or 314-292-1120 (Electronic)
E-Mail: [EMAIL PROTECTED]
<mailto:[EMAIL PROTECTED]> 


-----Original Message-----
From: Jonathan Fox [mailto:[EMAIL PROTECTED] 
Sent: Wednesday, March 05, 2003 1:04 PM
To: WEDI SNIP Privacy Workgroup List
Subject: Minimum necessary


Now that Privacy is right around the corner, a lot of people are
re-examining some of the Transactions work that has been done.

Here is a question that has privacy (minimum necessary) implications.

A provider performs an eligibility inquiry with their local HMO.  The
HMO responds with yes the member is eligible and here is a list of
their
benefits.  Clearly, the minimum requirements of the functionality of
the
transaction have been met, but how far can a payer go in giving
additional information (COB, HIC number, Group Number, Plan Number,
etc,
before you cross the minimum necessary (privacy) line.

Certainly, many of these pieces of information are not needed to get a
claim paid by that payer.  Is it the 
responsibility of the payer and/or is it within their right to divulge
information about other policies they may have.  

This is not a question about transaction functionality, as the
transaction clearly accommodates this data, but there seems to be a
slight contradiction with the minimum necessary clause of the Privacy
rule.

Thoughts please???

Jonathan Fox
Independent Health

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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/.   These listservs should not be used for 
commercial marketing purposes or discussion of specific vendor products and services.  
They also are not intended to be used as a forum for personal disagreements or 
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