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Back  RFI # 403: EB01=U

Formal vs. Informal Help Informal Formal

Submitter

Campbell Donna

Description

Our organization keeps membership information on labor acct employees, but does not maintain this information, as the labor fund has the most up-to-date eligibility status. A labor empl may not meet a 40 hour a week requirement, so he may not qualify for health benefits that week. Our organization returns an EB01=U and the labor fund's phone number to get the eligibility status of the labor member. Is this a violation of HIPAA because we are not returning EB01=1-8?

Submitter Assigned Keywords

EB01=U

Response

When an organization receives an eligibility request and they are not the true information source, such as the scenario you have identified, returning an EB01 = “U” (Contact Following Entity for Eligibility or Benefit Information) with the true Information Source’s contact information in the 2120 loop is a valid response and you are not obligated to return a status of Active or Inactive.

Recommendation

This will be clarified in the 005010 version of the Implementation Guide.
Submission 4/21/2006
Status Date 7/10/2006
Status F - Final
Primary References
Document 004010X092A1
Section1.3.7
Page20
Set ID271
Table2
Loop2110C
Segment Position1390
Segment IDEB
Element Position01
Industry NameEligibility or Benefit Information
Secondary References
RFI ID 359
Document 004010X092A1
SectionNote 5
Page218
Set ID270271
Table2
Loop2110C
Segment Position1390
Segment IDEB
Element Position01
Industry NameEligibility or Benefit Information