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Back  RFI # 208: HIPAA Search Options for Elig

Formal vs. Informal Help Informal Formal

Submitter

Doug Fielding

Description

New York Medicaid is not accepting 270 eligibility inquiry transactions that contain the HIPAA minimum search option (Subscriber MemberID, Patient First Name, Patient Last Name, Patient Date of Birth. They are additionally requiring the field Identity Card Number (qualifier HJ) in the REF segment for the Subscriber in the 2100C loop. I am requesting confirmation that my interpretation of the IG is correct, in that a payer must accept the above fields as the HIPAA minimum search option in order to identify a patient and may not require additional information such as the Identity Card Number.

Submitter Assigned Keywords

Eligibility HIPAA Minimum Search Option

Response

This issue is explicitly addressed in guide 004010X092 in section 1.3.8 on pages 21 and 22. The health plan is required to use the four "maximum data elements" to find a patient and must provide a response based upon that information. It is not consistent with this guide for a health plan to also require use of the 2100C REF segment with qualifier HJ.
Submission 2/25/2005
Status Date 5/16/2005
Status F - Final
Primary References
Document 004010X092A1
Section1.3.8
Page22
Set ID???