Matching 27x Request and Responses In Electronic Data Interchange Between HMSA And Its Partners
Matching 27x Request and Responses recommendations are given to facilitate electronic documents transmission. The matching of a 27x request transaction with its response, it is recommended that a unique trace number be submitted in TRN02 at the patient level (Subscriber or Dependent loop) and, for the 278-13 transaction only, at the service level. In some situations HMSA will split a 27x request transaction into multiple requests for internal processing and return multiple responses to the requester. Each of the multiple responses will contain the original trace number that was submitted on the request transaction (TRN02).
HMSA will split a 27x request transaction when the transaction contains requests for BlueCard and FEP members. A 27x transaction will also be split for the 278-13 transaction when submitting multiple service lines for BlueCard members where the UM06 Level of Service Code has a mixture of values (“03” = Emergency, “U” = Urgent, “E” = Elective) .
To avoid multiple responses for a single 27x request:
- Submit a single patient eligibility request (one Subscriber or one Dependent loop) within a transaction set (ST/SE) for transactions containing BlueCard and FEP members.
- Request claim status for a single claim for a BlueCard member on 276 transactions.
- Submit emergency and urgent service requests in a separate transaction from nonemergency and non-urgent services for BlueCard member on 278-13 transactions.