Please contact our Customer Support Team at customer.support@experianhealth.com regarding other questions you may have.

What are my options if the benefits I need aren’t provided in the enhanced response?

Our customer support group will be happy to work with the client administrator of your organization to find a mix of service type codes that will fit your needs. This only applies to EDI and IntelliSource clients.

How can I tell how many transactions were run using the enhanced response?
Will it be defined on my invoice?

Your invoice will display the those transactions separately.
We will also be adding those numbers to the online reports.

Will this new response effect IPS (In Process Scripting)?

No. This change shouldn’t have any impact to IPS.

How will this effect eCare Next?

For clients using eCare Next who manually trigger transactions, you will see a drop down box, similar to OneSource. You can choose the service type you need. If your transactions are being triggered automatically, we will send the standard 3 transaction inquiry unless you have chosen to opt out.

What if we change our mind and want to opt out later?

Please contact customer support to have the multiple transactions turned off. The ability to control this will eventually be added to the self service portal so you can control.

How will this affect my PPE (Patient Payment Estimator) estimates?

PPE will be using our new “precision service type” logic to determine how many transactions to run when making an estimate. The initial transaction will be a combination of Health Benefit Plan Coverage and Surgery service types. Once the responses are returned, the new logic will determine if there is enough data in the responses to generate an accurate estimate. If not, it will look at the services being rendered and choose an additional more specific service type to run to gather more benefits.

HIPAA allows for sending multiple service types in one transaction. Why have you chosen to send multiple transactions?

While HIPAA allows for multiple service types in one eligibility inquiry, UHC currently does not allow this. If multiple service types are sent in one transaction, they will treat the request as an generic service type.

Can’t you make UHC send more data in the response?

Unfortunately, no. We have expressed our concerns to UHC and they have been open to listening to any feedback we get from our clients. Because of their release schedules, changes to the response will not be considered until 2013 or later.

How will running multiple transactions effect the response time?

Currently the response time for the UHC 5010 eligibility response averages 5 seconds. We will monitor the response time closely to ensure that the response times stay within acceptable levels.

How will My Response affected by the new response?

In general this UHC change will have very little effect on My Response. It is possible that a particular benefit you’re accustomed to seeing in the UHC response may be missing if it’s not returned in the 5010 response or if it’s now coded differently.