In my experience most providers are set up to just send a general request
because most payers cannot respond to a specific request. However, even if
a provider sends in a general request of EQ01 = 30, the payer should send
back as much information as possible given the limitations of their core
system - including deductible, copay, coinsurance, visit limits, detailed
demographics, etc. That way, the requester can make their same generic
request of everyone without needing to worry what key will unlock the
riches of a content-rich response from a specific payer and conversely,
payers that can give back lots of information don't have to be limited by
the providers expectations.
Regards,
Laurance
Laurance Stuntz
Principal
Global Health Solutions
Computer Sciences Corporation
office phone: 781.290.1479
fax: 781.890.1208
email: [EMAIL PROTECTED]
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"Adams, Billie
Jo" <BAdams To: "WEDI SNIP Transactions
Workgroup List" <[EMAIL PROTECTED]>
@worldinsco.com> cc:
Subject: 270 transaction
06/04/2003 03:15
PM
Please respond to
"Adams, Billie
Jo"
To the providers:
How detailed of a request do you feel will be sent out the 270 transaction?
Are most requires, that you are setting up for, going to be mostly general
eligibility requests or more detailed benefit requests?
We are at a stale mate on how specific of a response we will need to
generate. If we only need to do the minimum because we don't think it will
be used to much, that is what we want to do. But in any case we want to be
prepared.
Any responses are appreciated.
Thank you
Billie Jo Adams
Project Analyst
World Insurance Company
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