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The following sections provide the history of all changes made to this document.
No changes. This is the first published version of the document.
The changes in this cycle address the following comments:
3048, 3228, 3230, 3231, 3252
The full text of the comments along with the Technical Committee's disposition can be reviewed on the HITSP Public Web Site.
The following changes have been made to the construct:
Identified updates to Unified Modeling Language (UML) diagrams
Defined all constraints to CAQH CORE Phase I Operating Rules
Added note regarding TP46 use for detailed pharmacy specific benefits
Made editorial changes based on comments
Upon approval by the HITSP Panel on March 27, 2008, this document is now Released for Implementation with one correction. Per the approved motion, the Technical Committee removed the constraint requiring the use of the Federal Tax Identification Number as identifiers in the X12 270/271 messages for the Sender and Receiver (ISA06 and ISA07). This occurred in Table 2-1 and Table 2-7.
This document has been modified to reflect the updated HITSP approach to categorizing standards as Regulatory Guidance, Selected Standards, and Informative References.
This document has been modified to accommodate the requirements specified in the HITSP RDSS56, 58, and 59 documents.
The following changes have been made to the construct:
Removed Generic from all occurrences of construct name
Modified Transaction Constraints Table 2-1 as follows:
- Added CORE Phase II Operating Rules # 260, 258, and 259 as constraints
- Replaced constraint to submit 270 transaction as a generic health plan coverage inquiry with one requiring one or more EQ segments.
Modified X12N 270/271 Data Mapping Table 2-7 as follows:
- Added CORE Phase II Operating Rules # 260, 258, and 259 as data mapping specifications
- Removed requirement for data element 270_2110C_EQ01_1365
- Added requirement for data segment 270_2110C_EQ
Added HIPAA to Regulatory Guidance Table 2-11
Added CAQH CORE Phase II Operating Rules # 260, 259, and 258 to Selected Standards Table 2-12
The changes in this construct address the following comments received during the Public Comment and Inspection Testing period (September 29 October 24, 2008).
5046
The full text of the comments along with the Technical Committees disposition can be reviewed on the HITSP Public Web Site.
This document has been modified to add "or acknowledgements" to the 271 transaction line in Figure 2-1 Eligibility Verification Flow Diagram.
Minor editorial changes were made to this construct.
Upon approval by the HITSP Panel on December 18, 2008, this document is now Released for Implementation.
Minor editorial changes were made to this document. Removed boilerplate text for simplification. The term actor was replaced with interface.
Upon approval by the HITSP Panel on July 8, 2009, this document is now Released for Implementation.
[1] This Transaction is constrained to health plan benefits coverage, including whether or not a health plan covering the individual includes a pharmacy benefit. Detailed pharmacy specific benefits coverage is handled in the HITSP/TP46 Medication Formulary and Benefits Information Transaction Package.
[2] Optionality = R for Required, or O for Optional, or C for Conditional. If applicable, conditional footnotes are further described below.
[3] This HITSP Transaction constrains certain portions of the X12N 270/271 Implementation Guide. The Implementation Guide contains other capabilities that are outside the scope of this transaction.
[4] Optionality = R for Required, R2 for Required if known, C for Conditional, O for Optional. If applicable, conditional footnotes are further described below.
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