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Real Time Inquiry (270) Request - PM

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Generate an on-demand request to include and submit client eligibility information in a 270 file.

*NOTE: Netsmart has introduced new Real Time 270/271 functionality that integrates myAvatar directly with RevConnect for eligibility Verification. As the existing Real Time 270/271 in myAvatar was created based on specific requirements for one client prior to the introduction of the 5010 HIPAA transactions, no changes will be made to the existing Real Time 270/271 myAvatar functionality.

myAvatar PM > Billing > Electronic Submission > Real Time Inquiry (270) Request

Through the Real Time Inquiry (270) request, the following information can be gathered in myAvatar PM:

  • Generic inquiry - Does a subscriber have coverage under a guarantor or payor?

  • Specific inquiry - Does a subscriber have coverage for a specific service or procedure? This information includes: benefit amounts, co-insurance, co-pays, and deductibles.
    Types of specific inquiries:

    • Service code
    • Procedure code
    • Procedure code and diagnosis code

This form does not provide a history of benefit use for the subscriber and does not process batch inquiries.

The Eligibility Inquiry (270) Submission form is used to submit a benefit eligibility inquiry.

  • The Enable 270/271 Transaction Sets registry setting must be enabled.

  • A service code must be associated with Service Type Code (270) (in the Service Codes form) to be included in a 270 request file.

  • Guarantors must have the 270 transaction set enabled through the Guarantors/Payors form, to be available for selection in this form.

  • Liability should be updated for charges in the 270 file (Close Charges form).

  • To enable the real-time functionality, the Eligibility Inquiry (270/271) Real-Time Setup form must be configured, and submitted with the real-time exchange server connection information.

  1. In the Client ID field, enter the client name or client ID, and select.

  2. In the Episode Number field, select the client episode.

  3. In the Guarantor field, select the guarantor. This list contains all guarantors assigned to the selected client and episode, that have the 270 transaction set enabled in the Guarantors/Payors form (Eligibility Inquiry/Response (270/271) section).

  4. In the Request Type field:

  • Select Generic to create a generic client inquiry.
  • Select Specific to create an inquiry for a specific service or CPT-4 code.

  1. In the Service Code field, enter the service code, and select.

  • The service code must be associated with a service type code (Service Type Code (270) field, Service Codes form).
  • Service codes that have Health Benefit Plan Coverage selected in the Service Type Code (270) field are used to create a generic eligibility inquiry.

  1. In the From Date field, enter the eligibility inquiry request start date. Dates must be entered DDMMYY.

  2. In the Through Date field, enter the eligibility inquiry request end date.

  3. In the CPT-4 Code field, enter the CPT-4 code, and select. This field is used for a specific CPT-4 code eligibility inquiry request.

  4. In the Modifier field, enter the modifiers assigned to the CPT-4 code. Separate each modifier with a comma (for example: M1,M2,M3,M4).

  5. In the Diagnosis Code field, enter the diagnosis code, and select.

  6. Click Process Request.

  • An eligibility inquiry (270) file will be created and submitted to the designated 270/271 real-time exchange server, defined in the Eligibility Inquiry (270/271) Real-Time Setup form.
  • An error will display if no valid data is found for the client and episode in myAvatar PM.

  1. Click Post Inquiry. 

  • The eligibility response (271) data that has been received will be posted to myAvatar PM.
  • A report will be generated that displays the details of the eligibility response (270) data.

 

► Registry Settings

  • Enable 271 Guarantor Mapping

  • Enable Real-Time 270/271 Submission

  • Enable 270/271 Transaction Sets

  • Enable HIPAA Version 5010

  • Enable Real-Time 270 Date Limitations

  • Enable Real-Time 270 End Date Limitation

  • Enable Real-Time 270 Start Date Limitation

  • Exclude Dashes From Subscriber Social Security Number

  • Enable Service Liability Check (270)

  • Limit Date Range

  • Maximum Date Range For Real-Time 270 Submission

  • Plan Coverage Description (2100C-EB-05)

► See Also

 

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