Section title: Requests for Interpretation
RFI #
2491
Service Authorization EDI Request Being Redirected
Description

Is the Health Plan HIPAA 5010 compliant if they accept a 278 service authorization request but then redirect the submitter to then call to request the authorization?  Below is the direction from their companion guide:

“Authorizations that contain radiology, oncology, radiation therapy and cardiology codes need to be submitted to “Payer A” XXXXXXXX.  For “Payer B” XXXXXXXX, please contact “Payer A” XXXXXXXX at XXX-XXX-XXXX.  For “Payer C” XXXXXXXX, contact “Payer A” XXXXXXXX at XXX-XXX-XXXX.

RFI Response

It is acceptable for the payer to respond to a submitted 278 with either an AAA or HCR segment to indicate why a transaction cannot be processed.

DOCUMENT ID
005010X217