Change Request Detail
Type of Request
Health Care Eligibility Requests or Responses
DSMO Process Completed
Business Reason
To allow for the accurate and appropriate identification of plan enrollees when "Patientís Member ID (or the HIPAA Unique Patient Identifier once mandated
for use)idenfitication" is not available.
Mandate more than one set of search criteria.  Currently only mandated search is:

Patientís Member ID (or the HIPAA Unique Patient Identifier once mandated
for use)
Patientís First Name
Patientís Last Name
Patientís Date of Birth

Standard should mandate these two searches at a minimum:

Patient's Social Security Number + Patientís Date of Birth
Patientís Member ID + Patientís Date of Birth

Consider also mandating a response to:

Patientís First Name+Patientís Last Name+Patientís Date of Birth

Patientís Last Name+Patientís Social Security Number
DSMO Category
Disapprove. Many organizationsí privacy policies prohibit responding to searches that are this general in nature. Therefore, we cannot support this as a mandated search option. This topic underwent extensive discussion in the creation of the 005010 TR3s. See section 1.4.8 Search Options in the TR3. No new information has emerged to justify reconsideration of this decision.
Appeal Recommendation