What is the Payer Responsibility to Validate the Sender for270/271 and 276/277?

[Jim Moores]

Hi All,     What is the Payer Responsibility to Validate the Sender for 270/271 and 276/277?  Should edits be set up for the 270/271 and 276/277 validating that the requestor is a covered entity?  We know the Providers that we have contracts with, so we're only talking about receiving these kinds of requests from "providers" that we don't know (provider number not on file).  Frankly, I'm not so worried about the 270/271, as that discloses only that the member has valid coverage.... the risk is in the transmitting claims status request for a claim that doesn't belong to that "provider"... either by in error or maliciously.  (We do some edits... ie they have to have the claim number, member id and the date of service).     Am I just being paranoid (little or no chance) or ....   Jim   Jim Moores - HIPAA Team Leader - Privacy Antares Management Solutions 23700 Commerce Park Road Beachwood, Ohio   44122-5832   [EMAIL PROTECTED] Phone: (216)292-1605 Fax:      (216)292-1619   ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ------------------------------------------------------------------------------ CONFIDENTIALITY NOTICE: This message is intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential or exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that you are strictly prohibited from printing, storing, disseminating, distributing or copying this communication. If you have received this communication in error, please notify us immediately by replying to the message and deleting it from your computer. Thank You, Antares Management Solutions. ==============================================================================