Registry



Back   Interactive Health Care Eligibility/Benefit Inquiry and Response (003070X007)

Purpose

The Interactive Health Care Eligibility/Benefit Inquiry and Response Implementation Guide describes the use of the EDIFACT IHCEBI message and the EDIFACT IHCEBR message for the following business usages:
  • Inquire on an individual's health care eligibility and coverage in an interactive mode (IHCEBI)
  • Respond to a request for information on an individual's health care eligibility and coverage in an interactive mode (IHCEBR)

The IHCEBI identifies the patient in question, the insurance subscriber, and the provider or orgainization requesting the information. The IHCEBR provides the plan coverage information, patient/subscriber identifiers, coverage benefits, and third party liability information.

Primary Trading Partners

Health care providers, such as hospitals, nursing homes, physicians, laboratories, dentists, and allied professional groups. Health care payers, such as federal and state agencies and their contractors, commercial insurers, and service organizations, third party administrators, plan providers, and other entities that process health care reimbursements.

References

This is the first implementation guide for this business purpose.

Coordination

ASC X12 Subcommittee's Property & Casualty Task Group's Claim Work Group (TG1/WG2) and Workers' Compensation/Disability Work Group (TG1/WG3).

Additional Information

Registered 4/27/1996 Published 9/1/1998
Transaction Set ID IHCEBI Standard Version 003070
ASC X12 DM# Owning Group X12N/TG2/WG1