This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.
Please go to www.ahrq.gov for current information.
Eligibility Checking (All UHMP)
UHMP Practice using OnCallData™ with a Formulary
Database sends X12 270 Requests and receives X12 271 Responses through RxHub to and from PBMs (Medco, Express,
* Anthem live as of 11/06
Jan—Dec '06: 176K + responses / 300K checks (~59% hit rate)
Foundation Standard: Eligibility (X12 270/271)
OnCallData™ sends name, dob, zip, gender to RxHub, gets formulary identifier in return (informs formulary selection for that prescribing session)
Numbers represent ALL of UHMP e-prescribing practices, including specialty. However, ¾ of UHMP eRx volume is represented by our study group prescribers in the 25 primary care practices (~ 30K of monthly UHMP total of ~40K eRx), so presumably ¾ of these eligibility transactions are coming from the 25 study group practices.
Previous Slide Contents Next Slide