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Eligibility Response (271) - PM

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Process a (271) file, which contains information received in a 271 file from a guarantor or payor. These responses include either verifications or rejections:

  • Generic inquiry - The subscriber’s eligibility for coverage under a guarantor or payor.
  • Specific inquiry - The subscriber’s specific coverage information. This information includes: benefit amounts, co-insurance, co-pays, deductibles, exclusions, and limitations relating to a specific procedure. When the eligibility response file is processed, financial eligibility information for the subscriber is updated.

Note: Depending on how myAvatar registry settings and system configuration are defined, when a 271 file is processed subscriber financial eligibility information may or may not update service liability, Financial Eligibility and Cross Episode Financial Eligibility records.

Prerequisites:

  • The Enable 270/271 Transaction Sets registry setting must be enabled.
  • A 270 eligibility request must have been submitted in the Eligibility Inquiry (270) Submission form.
  1. Go to: Avatar PM > Billing > Electronic Submission > Eligibility Response (271)
  2. In the Options field:
  • Select Load File to load a compiled eligibility benefit inquiry request file.
  • Select Compile File to assemble the benefit eligibility request into a temporary file.
    • The Eligibility Response (271) report is generated when the 271 file is compiled without errors.
    • This report details 271 response data.
    • Errors can be reviewed by generating the Eligibility Response (271) report (select Run Report in this field).
  • Select Run Report to generate the Eligibility Response (271) report for a 271 file.  The report details the data in a 271 file.
  • Select Dump File to generate a report of the compiled 271 file.- The report displays the text file created for a 271 file.
  • Select Post File to post the 271 file information to myAvatar PM. Posting the information updates the client’s financial eligibility.
  • Select Delete Loaded/Compiled File to delete a loaded or compiled 271 file. Information in the file can be compiled again into another file. Posted files cannot be deleted.
  1. In the File Path\Name field, enter the file path for the 271 file. The file is stored in the directory setup in the Facility Defaults form.
  2. In the Select File field, select the 271 file. This field displays the file status, date compiled, time compiled, and the user performed the compile.
  3. Select Process File to perform the action selected in the Options field:
  • Load File - the 271 file is loaded into myAvatar PM, and is ready to be compiled.
  • Compile File  - the loaded file is compiled into a temporary file.
  • The Eligibility Response (271) Report is generated if the file is compiled without errors.
  • Run Report - the Eligibility Response (271) Report is generated.
  • Dump File - the Eligibility Response (271) Dump File Report is generated.
  • Post File - the eligibility 271 file is processed by myAvatar PM.  The client’s financial eligibility information is updated.
  • Delete Loaded/Compiled File - the 271 file is deleted from myAvatar PM.

The Eligibility Response report contains the following sub-reports:

  • Response Data: Sorted by client and episode, and displays information for each generic and specific benefit inquiry response.
  • Rejection Data: Displays reasons the file was rejected, and the follow up action needed to process the file.
  • Errors Associated With Known Clients And Episodes: Displays errors with processing identified clients.
  • Errors Associated With Unknown Clients And Episodes: Displays errors with processing identified clients.
  • Errors Associated With File Load: Displays missing or incorrect data in the 271 file.
► Registry Settings

  • Allow 270 Submission For All Clients

  • Enable 270/271 Transaction Sets

  • Enable 271 Guarantor Mapping

  • Enable HIPAA Version 5010

  • Exclude Dashes From Subscriber Social Security Number

  • Limit Date Range

  • Maintain Unique Functional Group Control Numbers By Root System Code

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

  • Specify HIPAA Transaction File Input/Output Directories