Assuming the inquiry was through a phone call and that the HMO &Client were covered entities, the phone rep should provide the same level of benefit information made available through the 271 response and any HMO eligibility web applications to which the provider has access.
In short, there can be no incentive for the provider to use one mode of inquiry over another which means all avenues of disseminating eligibility information must provide the same level of detail. Understand that the 271 does provide comprehensive benefit information, but at this time the government regulates that the minimum response to an eligibility inquiry is a yes/no. Thanks, Lee M. Schmidt Magellan Behavioral Health HIPAA / I.T. Project Manager, Claims Applications Local: (314) 387-5445 Toll Free (St. Louis): 1-800-450-7281 ext: 75445 New Cell: (314) 960-0964 Fax: 314-387-5655 or 314-292-1120 (Electronic) E-Mail: [EMAIL PROTECTED] <mailto:[EMAIL PROTECTED]> -----Original Message----- From: Jonathan Fox [mailto:[EMAIL PROTECTED] Sent: Wednesday, March 05, 2003 1:04 PM To: WEDI SNIP Privacy Workgroup List Subject: Minimum necessary Now that Privacy is right around the corner, a lot of people are re-examining some of the Transactions work that has been done. Here is a question that has privacy (minimum necessary) implications. A provider performs an eligibility inquiry with their local HMO. The HMO responds with yes the member is eligible and here is a list of their benefits. Clearly, the minimum requirements of the functionality of the transaction have been met, but how far can a payer go in giving additional information (COB, HIC number, Group Number, Plan Number, etc, before you cross the minimum necessary (privacy) line. Certainly, many of these pieces of information are not needed to get a claim paid by that payer. Is it the responsibility of the payer and/or is it within their right to divulge information about other policies they may have. This is not a question about transaction functionality, as the transaction clearly accommodates this data, but there seems to be a slight contradiction with the minimum necessary clause of the Privacy rule. Thoughts please??? Jonathan Fox Independent Health --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
