I can provide the text, I think.
On page 13 of the 270/271 version 4010 IG, it says:
"The first approach is to assign each member of the family (and plan) a
unique ID number. This number can be used to identify and access that
individual's information independent of whether he or she is a child,
spouse, or the actual subscriber to the plan. In this approach, the
patient will be identified at the subscriber hierarchical level because a
unique ID number exists to access eligibility information for this
individual."
"Hal Scoggins"
<Hal.Scoggins@sb To: I <[EMAIL PROTECTED]>,
<[EMAIL PROTECTED]>
pa.com> cc:
Subject: RE: 270 Eligibility Subscriber
- Dependent loop.
06/18/02 10:04
AM
Deepan,
I can't find any mention in the 270/271 IG of putting the Dependent info at
the Subscriber level if he is uniquely identified. The only transaction I
know of that allows this is the 278. Can you direct me to the text in the
IG that you read as allowing this?
As to your questions, here are my opinions, for what they're worth...
1) IMO, it is not appropriate to put the Dependent info at the Subscribed
level in any situation.
2) I would expect the Member ID to be printed on the ID card, even if the
Insurance co. (illegally) uses the SSN.
3) This is closely related to #1. As I said, it is my opinion that there
should always be two HLs if the Patient is a Dependent.
4) I pass on this one.
I'll be interested to hear any other opinions.
Hal Scoggins
SBPA Systems, Inc.
(281) 679-7272 x116
-----Original Message-----
From: Deepan Vashi [mailto:[EMAIL PROTECTED]]
Sent: Monday, June 17, 2002 9:41 PM
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: 270 Eligibility Subscriber - Dependent loop.
Hi friends:
May be this was addressed earlier : 270 Eligibility Subscriber -
Dependent loop.
In Transaction set 270. There are two levels for Subscriber and
Dependent information.
If subscriber is the patient then dependent HL will not come.
But if subscriber is other than patient dependent HL is required.
As per IG if patient(dependent) is not a subscriber however dependant
can be uniquely identified (with Member Id) by insurance company,
patient (dependent) information will come at Subscriber Level.
My questions are:
1) Is it necessary(mandatory) to keep dependent information in the
subscriber level if he can be uniquely identified
2) Is this "Unique Id" for patient defined by insurance company and
printed on the insurance Card of the dependent member? or some
Insurance Companies use SSN, EIN or some other id.
Note: In 837P (IG page No: 119)Member ID (MI) can only be one of :
Subscriber Id, Patient Id, Health Insurance Claim Number
3) Suppose a company provides unique id to each patient, regardless
of whether he/she is a subscriber or patient.
In such case can Insurance company ask for two HLs to come in 270?
(Subscriber and Patient HL both).
4) If there are 2 approaches to 270 transaction, is it left to
trading partners to decide the method of implementation?
Your views on above will be highly appreciated.
Thanks and regards
Deepan Vashi
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