For the 005010X279 TR3 Section 1.4.8.1 (Required Primary Search Options), could you please clarify the meaning of "patient is in their database" in terms of case sensitivity? Assume that both trading partners support the Extended Character Set. The information source (payer) has the patient's last name stored in their database in all uppercase like "DOE." But the information receiver (provider) sends a 270 with the patient's last name in mixed case like "Doe." If all 4 of the required data elements are present in the 270 and exactly match an active plan member except for character case, then is it a violation for the payer to not respond with a 271 containing that member?
Several commercial payers are failing to respond to eligibility inquiries unless patient names are in all uppercase.
When both trading partners accept both the Basic and Extended Character Set, both upper and lower case are acceptable. All parties must agree to the use of the Extended Character Set. This should be defined in a Companion Guide.
Please see CAQH CORE for Operating Rules applicable to this transaction, which are outside the purview of X12.
https://www.caqh.org/core/operating-rules
Related RFIs: 951