Cascading search
Cascading search is an approach to matching the member in the request to the member in the payer’s system. Matching logic must be sophisticated enough to allow flexibility in using a mix of identifying data, so that providers can retrieve information even though they might not have consistent sets of identification for all patients. The four pieces of identifying data are member ID, first name, last name, and date of birth, and payers must be able to match using member ID and two other pieces of data. Alternative logic can be used to match on first name, last name, and date of birth. Version 7030 differentiates between informational errors and severe errors. An error code can be included in a full eligibility and benefit response as information to the provider indicating, for example, that the member ID was not found. A severe error is one where a match could not be found and the payer will not return the full eligibility and benefit response.
Cascading search employs iterations of search criteria. Payers must make multiple attempts to match a request containing member ID, first name, last name, and date of birth. Version 7030 outlines the recommended logical steps, though payers may customize the order in which the searches are performed. The payer would first search for matches in their database for only the member ID and date of birth. If no matches or multiple matches are found, a second attempt would be made with member ID, date of birth, and last name. And so on. A variation on the search could be, for example, trying the first three letters of the first name. Version 7030 also outlines what search steps must be taken if the request contains member ID, last name and date of birth, or member ID, first name and last name.
