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Eligibility Inquiry (270) Submission - PM

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Submit 270 information that was collected in the Eligibility (270) Request form. The eligibility inquiry (270) submission sends the information collected in the Eligibility Inquiry (270) Request form to a guarantor or payor.

Prerequisites:

  • The Enable 270/271 Transaction Sets registry setting must be enabled.
  • An eligibility inquiry file must be created in the Eligibility Inquiry (270) Request form, or through a real-time request.
    All 270 submissions from myAvatar PM will be available in this form for reporting, whether the requests were entered manually or generated through real-time processing.
  • Liability should be updated for charges in the 270 file (Close Charges form).
  1. Go to: Avatar PM > Billing > Electronic Submission > Eligibility Inquiry (270) Submission
  2. In the Options field:
    • Select Compile File to assemble 270 information that has been submitted in myAvatar into a file.
      • The Eligibility Inquiry (270) report is generated when the 270 file is compiled without errors.
      • This report details 270 submission information.
      • Errors can be reviewed by generating the Eligibility Inquiry (270) report (select Run Report in this field).
    • Select Run Report to display a summary of claim status information in the 270 file. The report details the data submitted in the eligibility inquiry file, and any errors encountered processing the 270 file.
    • Select Dump File to generate a report of the compiled 270 file. The report displays the contents of the 270 file.
    • Select Create File On Server For Submission to create the compiled 270 file into a text file. The file is stored in the directory setup in the Facility Defaults form.
    • Select Delete File to remove a claim status notification file. Information in the file can be compiled again into another file.
  3. In the Individual Or All Guarantors field:
    • Select All to compile the benefit eligibility inquiry file for all guarantors
    • Select Individual to choose a guarantor (Guarantor field).
  4. In the Guarantor field, select the guarantor.
  5. In the Through Date field, enter the last service date for services to be included in the 270 file.
  6. In the File Description field, enter the 270 file name.
  7. In the Select File field, select the 270 file. This field displays the compiled file status, date and time compiled.
  8. Click Process File to process the action selected in the Options field. If the file is compiled for a single guarantor and through date, the Sort File dialog displays.
    • Click Yes to compile the file. Click No to dismiss the dialog, and change the necessary information.
    • If the compiled file is missing information, the eligibility benefit inquiry cannot be submitted.
  9. Use the Eligibility Inquiry (270) report (select Run Report in the Options field), to review the missing information.
    The Eligibility Inquiry (270) report contains the following sub-reports:
    • Submission Data - Sorted by client and episode, and displays information for generic and specific benefit inquiries.
    • Required Data Missing: Header, Source or Receiver Data - Sorted by client and episode, and details missing header, source or receiver information.
    • Required Data Missing: Subscriber Data - Details missing subscriber information.
    • Required Data Missing: Dependent Data - Details missing dependent information
    • Required Data Missing: Subscriber/Dependent Inquiry Data - Details missing subscriber or dependent information.
    • Required Data Missing: Other Data - Details missing other information.
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