Healthcare Transactions Inquiry Assistance Needed

Impacting all lines of business

Attention Health Care Providers!
To ensure that the Health Insurance Portability and Accountability Act (HIPAA) mandated inquiry transactions for health care eligibility and benefits (270) and claim status (276) inquiries are managed efficiently and effectively we are looking for help from you.

The goal of this article is to highlight the importance of reducing unnecessary requests for patient data, which assists in timely and accurate exchanges, ultimately helping patients access care without unnecessary delays.

Providers should consult with those who handle their practice management systems and/or vendors to ensure they are following these best practice suggestions.

Here are some best practices to keep the process smooth and compliant:

• Submit requests only for scheduled services: Limit 270 eligibility and benefit requests to patients with upcoming appointments. Avoid sending bulk or duplicate inquiries for your entire patient roster.
• Be patient with claim status checks: Hold off on 276 claim status requests until at least seven days after a claim is submitted. Early or repeated status checks often result in “Not Found” responses and add unnecessary volume.
• Use accurate member information: Always reference the most current details from the patient’s ID card. This ensures transactions are valid and reduces errors or rejections.
• Reject out-of-area inquiries: If a provider operates outside the Par/Host Plan’s service area, their 270 and 276 requests should be declined. This helps ensure the proper handling of patient information and maintains system integrity.

Adhering to these guidelines supports a seamless experience for both providers and members, allowing everyone to focus on delivering and receiving quality care.

Questions?
Please work with your practice management team and/or vendor. You may also send an email to prov.partners@bcbsnd.com for any additional questions.