Skip to main content

270/271/834 Section - PM

  1. Last updated
  2. Save as PDF

Define 270/271/834 settings.

Prerequisites:

Health Care Eligibility Benefit Inquiry And Response (270/271)
  1. In the Support 270/271 Transaction Sets field, select whether or not to enable 270/271 support for the selected guarantor.
  2. In the Skip Liability Update Process If No Valid Response (271) Received For An Inquiry (270) field, select whether or not to skip the update process when there is no response. The Netsmart best practice is to set this field to 'No' as to not affect guarantor coverage without a valid response as to why a guarantor should be skipped/bypassed for liability distribution.
  3. In the Number of Days Between Eligibility Checks field, enter the number of days before re-submitting a client on the 270 that has been submitted previously. The Netsmart best practice recommendation is to leave this field blank to allow for all applicable client records to be included in the 270 compile regardless of the number of days between the last 270 compile.
Health Care Eligibility Benefit Inquiry (270)
  1. In the Include Rendered Services in 270 field, select the operational rule for rendered services.
  2. In the Include Scheduled Services/Appointments In 270 field, select the operational rule for scheduled services.
Health Care Eligibility Benefit Response (271)
  1. In the Information Source Identification Code Qualifier (2100A-NM1-08) field, select the qualifier.
  2. In the Information Source Primary Identifier (2100A-NM1-09) field, enter the primary identifier.
  3. In the Default Expiration Date (2100C/2100D-DTP-02) field, select the date of expiry.
  4. In the Subscriber Release Of Information field, select whether or not the subscriber has authorized release of information.
  5. In the Subscriber Assignment Of Benefits field, select whether or not the subscriber has assigned benefits.
  6. In the Add Or Purge Eligibility Tables field, select whether the 271 compile process should only update a client's data in the eligibility table if that data does not exist in the table (Add), or update a client's data in the eligibility table regardless of preexisting data (Purge).
Benefit Enrollment and Maintenance (834)
  1. In the Insurer Identifier Code Qualifier (1000B-N1-03) field, select the qualifier.
  2. In the Insurer Identifier Code (1000B-N1-04) field, enter the insurer code.
  3. In the Subscriber Release Of Information field, select the status of information release consent.
  4. In the Subscriber Assignment Of Benefits field, select whether or not the benefits were assigned or if they were refused.
  5. In the Default Expiration Date (2300-DTP-03) field, enter the date. This is used as the default eligibility date if it is not specified in the 834 file.
  6. In the Member Policy Amount Qualifier (2100A-AMT-01) field, select the qualifier to determine the AMT segment in Member Name Information (Loop 2100A) that should be used to populate the 'max_covered_dollars' field in the SYSTEM.eligibility_dependent_cov table.
  7. In the Add Or Purge Eligibility Tables, select whether the 834 compile process should only update a client's data in the eligibility table if that data does not exist in the table (Add), or update a client's data in the eligibility table regardless of preexisting data (Purge).
Batch Eligibility Fields

Several new fields were added to this form to support the 270/271 Batch Eligibility Verification Enhancements. The field names are defined below. Note that your form may differ slightly from the screenshot below depending on how your registry settings are configured.

Field Name Description
270 Submission File Extension Allows users to determine the file extension for the generated 270 file based upon payer requirements.
  • No entry is required.
  • Examples: .txt or .270 
Information Source Entity Identifier Code (2100A- NM1-01)

Allows users to define the Information Source Identifier Code the payer requires on a 270 eligibility request.

  • Valid options are:
    • Third-Party Administrator
    • Employer
    • Gateway Provider
    • Plan Sponsor
    • Payer
  • No selection is required.
  • Help Text: Review the payer’s companion guide to determine what identification code qualifier is accepted in 2100A NM1-01 for a 270 request.
  • This value will be used in 2100A-NM101 field in the 270 request for the payer unless it is overridden by a value saved in the Guarantor/Program Billing Defaults.
Information Source Entity Type Qualifier (2100A- NM1-02)

Allows users to define the Information Source Entity Type Qualifier the payer requires on a 270 eligibility request.

  • Valid options are:
    • Person
    • Non-Person Entity
  • No selection is required.
  • Help Text: Review the payer’s companion guide to determine what entity type qualifier is accepted in 2100A NM1-02 for a 270 request.
  • This value will be used in 2100A-NM102 field in the 270 request for the payer unless it is overridden by a value saved in the Guarantor/Program Billing Defaults.
     
Information Source Last Name Or Organization Name (2100A-NM1-03)

Allows users to define the Information Source Last or Organization Name the payer requires on a 270 eligibility request.

  • This is a free-form text box.
  • No entry is required.
  • Help Text: Review the payer’s companion guide to determine what Information Source Name is accepted in 2100A NM1-03 for a 270 request.
  • This value will be used in 2100A-NM103 field in the 270 request for the payer unless it is overridden by a value saved in the Guarantor/Program Billing Defaults.
Information Source Identification Code Qualifier (2100A-NM1-08)

Allows users to define the Information Source Identification Code Qualifier that the payer requires on a 270 eligibility request.

  • Valid options are:
    • Employer’s Identification Number
    • Electronic Transmitter Identification Number (ETIN)
    • Federal Taxpayer’s Identification Number
    • National Association of Insurance Commissioners (NAIC) Identification
    • Payor Identification
    • Centers for Medicare and Medicaid Services Plan ID
    • Centers for Medicare and Medicaid Services National Provider Identifier
  • No selection is required.
  • This value will be used in 2100A-NM108 field in the 270 request for the payer unless it is overridden by a value saved in the Guarantor/Program Billing Defaults.
Information Source Primary Identifier (2100A- NM1-09)

Allows users to define the Information Source Primary Identifier that the payer requires on a 270 eligibility request.

  • This is a free-form text box.
  • No entry is required.
  • Help Text: Review the payer’s companion guide to determine what Information Source Primary Identifier (Identification Code) is accepted in 2100A NM1-09 for a 270 request.
  • This value will be used in 2100A-NM109 field in the 270 request for the payer unless it is overridden by a value saved in the Guarantor/Program Billing Defaults.
Minimum Search Options

Allows user to identify the fields that must be saved for a client in order for a 270 request to be submitted for the payer. Organizations should reference the 270 Companion guide for this information.

  • This is a multiple select list box.
  • Options are: Last Name, First Name, Date of Birth, Gender, Subscriber Policy Number, Social Security Number, Medicaid ID
  • The options selected for the payer will be verified when running an individual client or batch 270 request. If the client does have not have all values populated, then they will not be included on the 270 request. They will show up on an error report indicating the value that is missing.
Search Options for Other Guarantor Coverage Requests

These are the fields that must be saved for a client in order for a 270 request to be submitted to this guarantor for services distributed to another guarantor.

  • This is a multiple select list box.
  • Options are: Last Name, First Name, Date of Birth, Gender, Policy Number, and Social Security Number
  • The options selected for the payer will be verified when running a batch 270 request for requests to other guarantors. If the client does not have all values populated, then they will not be included on the 270 request. They will show up on an error report indicating the value that is missing.
Single Date or Date Range for Subscriber Date

This will allow organizations to define if the payer accepts only a single date or date ranges for eligibility requests.

  • This is a radio button group.
  • Valid options are: Single Date and Date Range
  • If ‘Date Range’ is selected, then a selection is required in the ‘Date Range Specifications’ field.
  • If ‘Date Range’ is selected then when a batch is run for this payer, the eligibility request will be submitted as a date range.
  • If ‘Single Date’ is selected, a separate eligibility request will be submitted for each applicable date (based upon services or appointments).
Allowable Values for Subscriber Date

This will allow organizations to define the dates that will be accepted by the payer.

  • This is a multiple select list box.
  • Options are: Current Date, Past Dates, Future Dates
  • Help text: Review the payer’s companion guide to determine what they will accept in 2100C/2100D DTP-03 (Subscriber Date). Select all options that are accepted by the payer.
  • If ‘Past Dates’ is selected, then when a batch is run for this payer, the date or date range of the eligibility request can be for a date in the past. For example, when a batch request is made, and the date range entered includes past and future dates, then requests for past dates can be included.
  • If ‘Future Dates’ is selected, then when a batch is run for this payer, the date or date range of the eligibility request can be for a date in the future. For example, when a batch request is made, and the date range entered includes past and future dates, then requests for future dates can be included.

Date Range Specifications

This will allow organizations to define the date ranges that are accepted by the payer. For example, if an organization needs to request eligibility for a client for multiple months, but the payer only allows dates within the same month to be submitted in the subscriber date field, then a separate request would need to be submitted for each month within the date range on the batch request form.

  • This is a radio button group.
  • Valid options are: Individual Calendar Months and Multiple Calendar Months
  • This field is enabled and required when ‘Date Range’ is selected in the ‘Single Date or Date Range for Subscriber Date’ group box.
  • If ‘Individual Calendar Months’ is selected, then a separate request will be created for each month within the date range on the batch request form for which a service/appointment exists for the client. The ‘from’ date will be the first of the month and the ‘to’ date will be the last day of the month.
  • If ‘Multiple Calendar Months’ is selected, then a single request will be created for the date range of services/appointments for the client that cross over multiple calendar months. The ‘from’ date for request should be the first date of the month for the oldest service/appointment date for the client and the end date will be last day of the month.
  • The system needs to also take into account if ‘past dates’ or ‘future dates’ are allowed when creating the requests.

 

 

► Registry Settings
► See Also
► SQL Table
  • SYSTEM.eligibility_dependent_cov  

 

  1. Back to top
  • Was this article helpful?

Recommended articles

  1. Page type
    Reference
  2. Tags
    1. av:pm
    2. myAvatar PM User Guide
    3. role:billing
    4. search:ready