We’re improving our 271 eligibility response transactions to make it quicker and easier for providers to determine whether their patients have benefits remaining for certain services. Beginning June 25, 2015, the 271 eligibility response will include a benefit count— noting how much of a particular benefit the member has already accessed and the remaining dollar/visit amounts for which the member is covered. Previously, this information was only available by calling the Provider Service Center.
The updates will apply for Harvard Pilgrim members whose member IDs begin with “HP” (not applicable for Health Plans Inc. members or members of Harvard Pilgrim’s joint venture with UnitedHealthcare).
These benefit details will be available for service types that Harvard Pilgrim currently returns in the 271 eligibility response for which a benefit count applies; benefit details will be reported as days, visits, or dollar amounts. For any service types that have combined accumulators, the same benefit limit and remaining dollar/visit amount will be reported on each applicable service type line, with a message specifying that these service types share counters. For example, the message might read: “Combined total for physical, speech, occupational therapy.”
If you have any questions about this new feature, please contact the Harvard Pilgrim EDI Team at EDI_team@harvardpilgrim.org or call 800-708-4414 and select option 1, then option 3.