Questions Submitted by the Public, by Date Posted to the Website. Providing additional information to standard transactions

11/02/2001

If a covered entity adheres to the data content requirement, can they also provide additional information using other technologies?

For example, if a health plan has a Web query solution for claim status, and meets all data content requirements for the 276 request and the 277 response, could they also provide additional information regarding the status of the claim? An example of additional information would be to provide claim resolution instructions for denied claim, or a statement that would better clarify the action taken on the claim.


7/1/2001:

A health plan may not add additional information to any of the standard transactions. It may, however, provide additional information through a separate mechanism. For example, the web-based service described in the question could provide additional information on a web page separate from the web page containing the standard data content. The resolution of the standard transaction cannot depend on the additional information.

Health care providers and health plans that have a business need for additional information are encouraged to work with the Designated Standard Maintenance Organizations to submit a request to modify the standard(s). Section 162.910 established criteria for the processes to be used for such modifications.