Skip to main content

270/271 Overview - PM

  1. Last updated
  2. Save as PDF

Process 270 and 271 electronic transactions.

The Eligibility Inquiry 270 file is an electronic request submitted to a guarantor or payer to verify a client’s eligibility with that guarantor.

The Eligibility Response 271 file is an electronic response from a guarantor or payer with a response to an Eligibility Inquiry 270 request, that defines a client's eligibility with that guarantor.

When a 270 file is compiled, data is collected throughout myAvatar PM for inclusion in the 270 file.

  • Generic requests cover general information: 

    • Eligibility status (i.e., active or not active in the plan)
    • Maximum benefits (policy limits)
    • Exclusions
    • In-plan/Out-of-plan benefits
    • C. O. B. Information (Coordination of Benefits)
    • Deductible
    • Co-pays
      This information can include generic eligibility requests (is the client covered with the guarantor), and specific requests (is the client covered for a particular service).

  • Specific requests cover more detailed information: 

    • Procedure coverage dates
    • Procedure coverage maximum amounts allowed
    • Deductible amounts
    • Remaining deductible amounts
    • Co-insurance amounts
    • Co-pay amounts
    • Coverage limitation percentage
    • Patient responsibility amounts
    • Non-covered amounts

  • When the 270 file is compiled and submitted to the guarantor, all 270 information that has been collected in myAvatar PM up to that point is included.
    270 information is then sent to the guarantor or payer in a 270 file. The response from the guarantor is sent back in a 271 file.

Form Setup

These forms control how data is collected for the 270 file, and how 271 response data is processed in myAvatar PM.

  • Facility Defaults
    The file path for electronic files is defined in the Output Path On Server For Electronic Files field.

  • Guarantors/Payors (270 / 271 / 834 section)
    The guarantor has to be set up to process 270/271 transactions. The information entered in this form controls which information is entered for the guarantor in the 270 file. It also controls the types of inquiries the guarantor supports (generic versus specific).

  • Guarantor/Programs Billing Defaults (Eligibility Inquiry (270) section)
    This section covers how information is entered by default in a 270 file, for a guarantor and program combination. This information must be entered in order to process the 270 file.

  • Financial Eligibility forms (Guarantor Selection section)
    Eligibility Inquiry (270) Status - The client can have 270 status information marked in myAvatar PM, so that it will be collected and sent when the next 270 file is submitted.

  • Service Codes (Add/Edit Service Codes section)
    Service codes must be associated with a Service Type Code to be included in the 270 file for service code specific setup. Service Type Codes are defined in the Dictionary Update form (Other Tabled Files: 270099).

Real Time 270/271 Process

The 270/271 real time process allows for a single client submission and a single client response. Initial Real Time 270 submissions go through the default guarantor, and all eligibility is returned on the corresponding 271. This real-time functionality was developed for one agency who was using myAvatar PM. This functionality is currently not being supported in myAvatar. If agencies want real-time 270/271 support, they will need to use RevConnect.

Note: The payer/intermediary must be able to accept real time submissions.

Note: Depending on the the payer or intermediary that the Real Time 270 requests will be submitted to, additional development may be required.

270/271 real-time exchanges can be performed: 

The following events act as Real Time 270 triggers:

  • myAvatar PM
    • Filing of the Admission form.
      The items used to verify the client will be based on the specific intermediary that is validating the 270 submission. Examples would be Policy Number, Date of Birth, SSN and Gender.
    • Clicking the Review Financial Eligibility button on the Cross Episode Financial Eligibility form if the Enable 270/271 Submission on Cross Episode Financial Eligibility registry setting is set to '2'.
    • Clicking the Review Financial Eligibility button the Financial Eligibility form if the Enable 270/271 Submission on Financial Eligibility registry setting is set to '2'.
    • Updating Liabilities.
      If the system is set up to submit a Real Time 270 anytime a liability update occurs, the system will queue the clients so that multiple 270 files will not be submitted for each client.
    • Creating an Interim Billing Batch file.
  • myAvatar MSO

The 270 Submission information that was generated through a real time request can be reviewed in the Eligibility Inquiry (270) Submission form.

Real Time Setup

  • Eligibility Inquiry (270/271) Real-Time Setup
    Define network access points for real-time 270/271 eligibility inquiries.

  • Guarantors/Payors (270 / 271 / 834 section)
    The guarantor has to be set up to process 270/271 transactions. The information entered in this form controls which information is entered for the guarantor in the 270 file. It also controls the types of inquiries the guarantor supports (generic versus specific).

  • Guarantor/Programs Billing Defaults (Eligibility Inquiry (270) section)
    The default guarantor is used for all Real Time 270 submissions. The Real Time 271 that is returned can contain eligibility for multiple guarantors.

► Registry Settings

 

  1. Back to top
  • Was this article helpful?

Recommended articles

  1. Page type
    How-to
  2. Tags
    1. av:pm
    2. myAvatar Billing
    3. myAvatar Electronic Submission
    4. role:billing
    5. search:ready