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Back  RFI # 246: 276 inquiry results intention

Formal vs. Informal Help Informal Formal

Submitter

Greg Fisher

Description

In Section 1.3.2 of the 276 Healthcare Claim status request and response it states that "when the 276 does not uniquely identify the claim within the payer's system, the response may include multiple claims that meet the identification parameters supplied by the requester." In the event that the identification parameters are not sufficient to identify a single provider, such as when only the TaxID and name are submitted and there are multiple name matches within the same TaxID, is the payer allowed to return all the claims for all providers that meet the criteria?

Submitter Assigned Keywords

276 multiple responses

Response

The 004010X093A1 guide requires the claims returned match the request data parameters. The guide does not make any statement regarding which claim parameters, in what order, or to what extent the parameters must be used for the ‘matching process’. Consequently, the claim request data parameters used by a payer for their matching process may vary from payer to payer.

The claim parameter data is positioned within the Subscriber or Dependent level.

In the event that identification parameters (i.e., tax id) are not unique to a single provider, and the subscriber or dependent claim data parameters identify 'matches', the Information Source could return multiple claims for the same tax ID that meet the subscriber or dependent claim data parameters requested.

This statement does not address HIPAA Privacy issues related to release of individually identifiable health care information.
Submission 4/21/2005
Status Date 6/28/2005
Status F - Final
Primary References
Document 004010X093A1
Section1.3.2
Page11
Set IDn/a