Alex,
From the X12N 270/271 version 004010 Implementation Guide page 20:
Section 1.3.7 - HIPAA Compliant Use of the 270/271 Transaction Set
271
"An information source must respond with either an acknowledgment that the individual
has active or inactive coverage or that the individual was not found in their system."
The appropriate AAA03 value in 2100C would be one of the following if no 2000D loop
exists:
67 - Patient Not Found
75 - Subscriber/Insured Not Found
The appropriate AAA03 value in 2100C would be one of the following if 2000D loop
exists:
75 - Subscriber/Insured Not Found
77 - Subscriber Found, Patient Not Found
The appropriate AAA03 value in 2100D if 2000D loop exists would be:
67 - Patient Not Found
I hope this clarifies the issue for you,
Stuart Beaton
Vice President
Washington Publishing Company
Co-Chair X12N/TG2/WG1 Health Care Eligibility Work Group
-----Original Message-----
From: Leah Hole-Curry [mailto:[EMAIL PROTECTED]]
Sent: Tue 6/25/2002 12:14 PM
To: [EMAIL PROTECTED]
Cc:
Subject: RE: an inquiry for a non-existing member
The official comments to transactions standard at page 50340 support
that a response would be required to a 270, and any transaction for
which the health plan has applicable information:
Comment: "One commenter suggested that we clarify the requirements to
clearly state that while health plans must implements the 270/271
Eligibility request/response, they are not required to respons to all
requests sent in the 270."
Response: "We do not agree. A health plan may not reject a standard
transaction because it contains information the health plan does not
want. This principal applies to the data elements of all transactions
in this rule. Health plans must accept a complete 270 and must respond
with all applicable responses that are included in the 271..."
Leah Hole-Curry
FOX Systems, Inc.
602.708.1045
Information transmitted is confidential and may be proprietary to FOX
Systems, Inc. It is intended only for the person or entity to which it
is addressed. Anyone else is prohibited from disclosing, copying, or
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error, please notify sender immediately, or us at www.foxsys.com and
delete from your system.
>>> [EMAIL PROTECTED] 06/25/02 08:38 AM >>>
Alex,
My opinion is that yes, a 271/277 response is required for a 270/276
inquiry
either providing the answer(s) to the question posed or indicating why
it is
not possible to answer specifically.
Just think of the analogy of a phone call....if your call center person
can't respond to the specific question being asked by the caller, what
do
they do/how do they respond? I'm sure they don't just hang up the phone!
Rachel
-----Original Message-----
From: Alex Chernyak [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, June 25, 2002 10:25 AM
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: RE: an inquiry for a non-existing member
Rachel,
Is it mandatory to respond (271 or 277) when a member is not found
on the membership system? Like status code 33 for 277 - subscriber &
subscriber id not found.... thanks
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