Our gurus can quote chapter and verse, but the basic rule is that a Health Plan MUST support 270/271 AND 276/277 AND 278 AND 820 AND 834 AND 837/385 if requested by the provider, and they do the business function at all. Thus, the only way they can get out of supporting 270/271 is by not supporting any type of eligibility inquiries (and, if they accept claims, I don't see how a claim could not be classified as an inquiry about eleigibility -- getting paid says "Yes, the patient was eligibile" -- getting denied may be for the reason "the patient was not eligible")
The opinions expressed here are my own and not necessarily the opinion of LCMH. Douglas M. Webb Computer System Engineer Little Company of Mary Hospital & Health Care Centers [EMAIL PROTECTED] "This electronic message may contain information that is confidential and/or legally privileged. It is intended only for the use of the individual(s) and entity(s) named as recipients in the message. If you are not an intended recipient of the message, please notify the sender immediately, delete the material from any computer, do not deliver, distribute, or copy this message, and do not disclose its contents or take action in reliance on the information it contains. Thank you." ----- Original Message ----- From: <[EMAIL PROTECTED]> To: "WEDI SNIP Transactions Workgroup List" <[EMAIL PROTECTED]> Sent: Wednesday, February 05, 2003 11:47 AM Subject: Convincing healthplans of the need to support 270/271 We have relationships with many health plans for eligibility processing. One in particular has told us that their HIPAA consultants told them that they don’t need to worry about anything but the rosters they provide doctors/groups. They seem to think online eligibility ANSI requirements are nice but not something they have to worry about. Can you tell me/give me the section of HIPAA doctrine that talks about this so I can share with them and make him aware of why they needs to pay attention to this topic? This is not an isolated occurance. Many healthplans I talk to do not feel the need to support the 270/271. Thanks for your help with this and your insights. Larry A. Saltzman, MD' CEO Insurance Benefit Spot Check, Inc. Sacramento, CA --- 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 unprofessional communication at any time. You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- 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 unprofessional communication at any time. You are currently subscribed to wedi-transactions as: [email protected] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
