270271
HETS allows users to submit HIPAA compliant 270 eligibility request files over a secure connection and receive 271 response files. Submitters must develop or acquire a tool to construct and send 270 eligibility request files and receive and deconstruct 271 eligibility response files in a real-time environment. HETS 270/271 application supports real-time transactions only. COB-270-271 Non-GHP Interface Specificationv3.0.doc Page 5 of 17 . Medicare Coordination of Benefits (COB) System Interface Specifications 270/271 Health Care Eligibility Benefit Inquiry and Response . HIPAA Guidelines for Electronic Transactions Companion Document for Mandatory Reporting Non-GHP Entities
The HIPAA act created the 270/271 EDI transactions to make this exchange of information electronically. Payers are required by law to respond to electronic Eligibility requests and the healthcare industry is pushing for the responses to be sent in real time. Avoid annoying IVR systems and spending countless hours collecting information over the information available to the reader through the TR3 implementation guide for the 270-271 transactions. The chapter delivers BCBSNC-specific information about the handling of these transactions. The chapter consists of three sections: • a general section with material applicable to the processing of eligibility inquiries and
