Healthcare Eligibility, Coverage and Benefit Request (270) and Response (271) additional notes concerning batch and timing

Healthcare Eligibility, Coverage and Benefit Request (270) and Response (271) EDI transactions were already discussed earlier in the blog. You can find general information about these healthcare EDI transactions as well as the description of the relationship during the processing of Healthcare Eligibility, Coverage and Benefit Request (270) and Response (271) transactions.

Healthcare EligibilityAs mentioned earlier, 270 Requests can be submitted in batch form. Batch allows a Provider of Service to send a 270 Request for all patients they plan to see during a set timeframe, for instance, the next week of business. As more and more Providers of Service are becoming capable of sending 270, batched files are increasingly becoming popular. The Healthcare Eligibility, Coverage and Benefit Request (270) and Response (271) ANSI specification manual does recommend sending more than ninety-nine requests in a single 270, it does allow for a greater patient volume. The Provider of Service and Insurance Company must both agree to the elevated level and set forth some kind of reasonable limit. Most Insurance Companies are prepared to handle greater than ninety-nine requests but a Provider of Service should inquire with the Insurance Company prior to sending any request with more than ninety-nine patients.

Insurance Companies typically return 271 Responses as soon as the eligibility has been verified and the EDI file is created. This could result in many 271 Reponses to be sent; each in their own file. While other times the Insurance Company could send 271 Responses on a schedule, for instance, every 30 minutes or every 2 hours. This process allows for the Insurance Company to send a batch 271 Response of all eligibility verified by the scheduled timeframe. This creates an efficiency with the Insurance Company but delays responses to the Provider of Service based on whatever the timeframe is on the delivery schedule. A best practice would be to return a 270 Response as soon as the eligibility is verified; in addition to working towards a Real Time environment.

Healthcare EligibilityTiming of 270 Requests is dependent of the Provider of Service’s office workflow. Some prefer sending a batch of 270 Requests at the beginning of the week for all the patients they plan to see that week. Some will send many individual 270 Requests every day to verify the day of service. A best practice would be to send a batch 270 file daily of patients scheduled for the next day. Insurance Companies often have scheduled times when they are not able to return a 271 Response due to weekly or daily system maintenance or system outages. Providers of Service should be familiar with the Insurance Companies system availability. During these times and Insurance Company can typically still receive the 270 Requests but the 271 Responses could be delayed.

Ultimately, Providers of Service want Real Time eligibility. Most try and obtain this with web based options provided by the Insurance Companies. This method can be effective but it typically does not offer a batch submission solution. Although the specifications allow for a Real Time option, the method of delivery is more often then not the delay in Real Time. A Provider of Service often has a system capable of creating a 270 Request fairly quickly. The same is also true of an Insurance Company’s ability to create a 271 Response for the request received. It is the communication piece that does not have many standards and thus creates delays in delivery.

More about strategies for successful EDI implementation

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