EDI IHCEBI Interactive health insurance eligibility and benefits inquiry and


EDI IHCEBI Specification

The IHCEBI message is sent from institutional or individualhealth care providers or those providing related administrativeservices to a funding institution to obtain health insuranceinformation from a patient's health plan prior to or at thetime of admission or treatment. This inquiry message will allow a health care provider to givetheir patient an estimate of cost for certain treatments, orassess their own financial risk associated with certaintreatments, and provide the patient with informed financialchoices regarding their health care options. Each inquiry can provide information to the health plan about aservice being considered, (e.g., actual or expected servicedates, actual or expected duration of hospital stay, andplanned services). An inquiry can also contain informationabout the treating and referring practitioner, if they are notthe health care party making the inquiry. The response message will provide information regarding whatbenefits are available to the patient based on their healthplan contract and the information provided with the inquiry.This can include financial information, such as, co-payamounts, deductible amounts, limitations, and exclusions. Each response can also provide information regardingadministrative issues concerning a covered benefit, such as,indicate who is the primary provider for a service, contactinformation for the health plan and patient, and policy rules,such as, certain screening exams can only be done once everytwo years. This message can only be used with ISO 9735 Version 4 or later.


Accredited Standards Committee X12. ASC X12 Standard [Table Data]. Data Interchange Standards Association, Inc., Falls Church, VA. http://www.x12.org