Eligibility TAG Meeting Notes – 1/27/16
Agenda items
1. Meeting to order – Kathy Harvey, co-chair
Discussion
Action Item
Kathy convened meeting and stated meeting
objectives.
2. Anti-trust statement:
http://www.health.state.mn.us/auc/pdfs/antitrust.pdf
3. Introductions – Please e-mail your attendance to
[email protected]
4. Review and discuss limited exception for non-HIPAA payers
TAG agreed to include the limited exception for
270/271 for non-HIPAA payers in their 2016 work
plan.
Can we push to remove this exception? Providers are
required to submit electronic claims; payors should
be required to follow other required transactions
such as the 270/271.
5. Review of 2015 Accomplishments
Kathy presented list of the TAG’s 2015
accomplishments.
6. Develop Eligibility 2016 Work Plan
a. 2016 calendar – how often to meet?
i. Annual maintenance of companion guide
b. Should TAG work on barriers identified in NCVHS?
c. Do best practices address all pain points in 2015
survey?
d. Is there interest to develop AAA errors scenarios?
e. TAG submission to AUC newsletter re Eligibility
transactions?
a. TAG agreed to continue meeting monthly and
voted to approve the 2016 calendar as posted on
the AUC website.
b. Discussion postponed. TAG would like time to
review letter submitted to NCVHS. Agenda item
for next meeting. Kathy requested MDH post on
the Eligibility TAG’s webpage.
c. TAG reviewed pain point results from the 2015
survey to confirm if all issues had been addressed
and/or resolved. All had been addressed except
mental health, payer contact to address EDI
complex issues, and lack of clearly defined AAA
errors.
Members reviewed the 270/271 Service Type
Inquiry/Response best practice and found that
some of the mental health benefits issues were
Bullet points in #6:
b. MDH will send to Theresa and
Kathy for distribution to TAG –
post to AUC website on TAG’s
home page
c. MDH will send Service Type
Inquiry/Response best practice to
Ops to approve – post on AUC
website after approval
d. Providers are to prepare and
send AAA scenarios (pain points)
they would like to see
standardized or definitions
needed to Kathy Harvey or
Agenda items
Discussion
addressed; but not the return of information for
specific mental health benefits such as neuro
psych test. Providers must call the payers for this
information. (Tim confirmed the Service Type
Inquiry/Response and Service Type 60 best
practices are not the same and the former is
ready to be submitted to Ops for approval).
It was noted during discussion the 270/271
supports the return of procedure requests.
Payers are not returning this benefit information
because it is not currently mandated and will
require a significant amount of work to respond
to that type of specificity.
Kathy asked payers if there is a tool on their
website for providers to get this information
rather than use up resources for a phone call.
Payers stated they do not provide info for a
specific benefit. Provider portals are not allowed
to show more than what is on 271 (HIPAA
regulation).
Additional issues/pain points not listed in 2015
survey but discussed at today’s meeting were:
i.
Changes payers are making to their
insurance cards are becoming an issue (pain
point) for some providers. In the past,
payers put EDI numbers on the patient’s ID
cards, now they are just putting various
logos on the cards, which is confusing and
places undue hardship on providers in
determining the patient’s payer.
ii. Uniform definitions for member, subscriber
and patient. Tim stated he believes WEDI
has a workgroup currently working on
standardize these definitions.
Action Item
Theresa Noponen for next
meeting agenda
Agenda items
Discussion
d. TAG agreed to work on this issue as part of their
2016 work plan. AAA errors for membership have
been standardized and are currently in
implementation guide. It is up to provider
community to inform of specific pain points and
those to be addressed first.
Suggestions were made to begin with
background/education of AAA errors or with an
overview of the eligibility 270/271 and
definitions. Putting the information in a FAQ
format would be most helpful for new folks.
e. Members did not wish to commit to monthly
submission of 270/271 articles in the AUC
Update. Instead articles to submit will depend on
information discussed during meetings. Members
agree if topic(s) is of interest and information
should be shared in newsletter.
7. Other Business
Payers were asked their perception of what does the
future hold for electronic insurance cards or
insurance cards with bar coding for smart phones.
BCBS electronic view may have link on portal for
provider to obtain member ID; not sure. CentraCare
has discussed installing scanners to accommodate bar
codes and/or smart phone card images, but waiting
for payors (are they going to have available) before
incurring the expense to change out scanners, which
is available with their system and has ability to scan
and pull in coverage/benefit info. There seems to be
communication (rumors?) payers would send paper
copies via email to patients to present and providers
scan bar code. None of the payers on call are aware
of the change to no longer provide members with ID
cards. So far, patients have not presented the paper
cards; perhaps still in development.
Action Item
Agenda items
Discussion
Next agenda – hope to have an update from the X12
meetings, we had a few members attend.
Next meeting: February 24, 2016
2:00pm – 4:00pm
Action Item