We're not really worried about how folks do eligibilities in the short term (pre-HIPAA).
But when H-day arrives, an 800 number is no substitute under HIPAA for processing of eligibility inquiries: all payers must support the 270/271 Health Care Eligibility Benefit Inquiry and Response standard transaction sets. If a payer's support of the 270/271 sucks compared to its 800 number or DDE capabilities, that supposedly is a HIPAA violation (because it would discourage a provider from using the standard 270). Listen folks: I didn't make the law. But at least here in the ID & Routing group, we can try to put together a framework whereby payers can easily support the 271 standard transactions when submitted a 270 by any provider. This is as clear-cut a case as I've ever seen of payers having to take in standard transactions on a non-discriminatory basis: no "vetting", no "certification," no "enrollment," no nothing, period - just like the 800 number. William J. Kammerer Novannet, LLC. Columbus, US-OH 43221-3859 +1 (614) 487-0320 ----- Original Message ----- From: "David Frenkel" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Thursday, 30 May, 2002 12:32 PM Subject: RE: TA1 responding to non-participating health care providers Mimi, As alluded to by Bruce, the Blues have this process in place which includes an 800 number for eligibility. State Medicaids are talking about accepting out of state Medicaid claims; I think the details are still in the works. For out of network claims for the short term you may have to stick to paper. Regards, David Frenkel Business Development GEFEG USA Global Leader in Ecommerce Tools www.gefeg.com 425-260-5030 ----- Original Message ----- From: "Bruce T LeGrand" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Cc: <[EMAIL PROTECTED]> Sent: Thursday, 30 May, 2002 11:42 AM Subject: RE: TA1 responding to non-participating health care providers Mimi, in the case of the blues, you would send your eligibility request to the Iowa version of the blue plan, whomever that may be. That's part of the "national" agreement the blues have through their interplan transaction service. ------------------( Forwarded letter 1 follows )-------------------- Date: Thu, 30 May 2002 09:26:49 -0500 To: BRUCE.LEGRAND, [EMAIL PROTECTED] From: Mimi.Hart[HartAM]@crstlukes.com.comp Subject: RE: TA1 responding to non-participating health care providers Requesting clarification on this point.. One of your clients visits Iowa (vacation hotspot that it is)...a place you don't have a large presence. He is injured and end up at one of my hospitals. We don't have a trading partner agreement with you, as we have no prior relationship. We can't send you an automated eligibility inquiry, as we don't have your routing #. Do we have to train our registration staff to call and ask for routing #? What do we do to get the electronic process going? Or do we have to program our system to automatically drop to paper when the claim is processed? (totally shoots the standardization process.....) Mimi Hart Research Analyst, HIPAA Iowa Health System 319-369-7767 (phone) 319-369-8365 (fax) 319-490-0637 (pager) [EMAIL PROTECTED]
