----- Original Message -----
From: Provider Caucus of X12's Insurance Subcommittee (X12N)
To: Healthcare Providers
Via: David A. Feinberg, C.D.P.
Subject: Statistics on Eligibility Responses

The Provider Caucus is interested in evaluating the impact that the
following required alternate search options for eligibility lookups
could have on positive response rates:
1) member id + last name + first name
2) member id + date of birth

Any statistics you would be willing to share on the rejection rate on
eligibility lookups based on
member id + last name + first name + date of birth
by payer category (Medicare, Medicaid, BCBS, Managed Care, Commercial)
would be very helpful.

If available, please also supply the percentage of rejections due to
discrepancies between the payer database and the data available to the
provider for name or date of birth, or when these data items are not
available to send.

If your statistics were not based on lookups on the 4 data elements
because the payer voluntarily requires fewer than that, we would still
like to see the response rates. Just note what fields the lookups are
based on.

We would be happy to receive any partial statistics that you have as
well.

Please send your reply to Betsy Clore ( bclore@... ) and Karyn
White ( kmw1291@... ) by May 7.

Thank you for your help.

Betsy Clore
Wake Forest University Health Sciences
WFU Physicians Information Systems
Medical Center Blvd.
Winston-Salem, NC 27157
(336) 716-0344