Capability

CAP 140 - Communicate Benefits and Eligibility

This Capability addresses interoperability requirements that support electronic inquiry and response about a patient’s eligibility for health insurance benefits. The information exchanged includes the following: • A patient’s identification (e.g., name, date of birth, and the health plan’s member identification number) • Communication of a member’s status of coverage and benefit information and financial liability • Access to information about types of services, benefits and coverage for various medical care and medications This Capability provides clinicians and healthcare providers with information about their patient’s health insurance coverage and benefits.

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Construct	Title / Version	Referenced by	Status	Document Access
CAP 140	Communicate Benefits and Eligibility Version:1.0	IS 9 V:1.0.2 IS 7 V:1.1.1 IS 91 V:0.0.1	Released (Panel Approved)	DOWNLOAD

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Reference Documents

Acronyms
AHIC Use Cases
Conventions (naming and numbering)
Glossary
Harmonization Framework
Interoperability Specifications Overview