Change Request Detail
No.
1131
Date
1/28/2011
Submitter
Type of Request
Health Care Eligibility Requests or Responses
Status
DSMO Process Completed
Business Reason
The requirement to return all plan information prevents streamlining the response.  This can also prevent a timely response (under 60 seconds) in a real-time situation.  Some payers carry benefit information in separate systems.  For example, dental information can be carried in a different system.
Suggestion
Change the requirement to return all plan information when specific benefit information is requested to apply only to a batch request and response.  For example, when a generic request (Service Type Code 30) for benefits is requested, it is required to return dental and other benefit information.
DSMO Category
B
Recommendation
Approve. The DSMO recommends that the submitter work with X12 to further identify the business need and appropriate method to address this situation.
Appeal Recommendation