Guarantor/Program Billing Defaults - Eligibility Inquiry (270) Section - Fields Enabled by Registry Settings
These are the fields on the Guarantor/Program Billing Defaults form Eligibility Inquiry (270) Section that are enabled by System Administrators using Registry Settings.
| Field | Option |
|---|---|
| Reference Identification Qualifier 2 (2100B-REF-01) | Select the secondary reference ID type. |
| Information Receiver Additional Identifier 2 (2100B-REF-02) | Type the information receiver additional identifier. |
| License Number State Code 2 (2100B-REF-03) | Type the license number state code. |
Note: The populate fields below replace the selected value in a client's financial eligibility form with the corresponding value in the 270 file.
| Field | Option | Notes |
|---|---|---|
| Populate Subscriber Name... | Select Yes to use the value from the Subscriber Policy Number Override (2010BA-NM1-09) field in the Financial Eligibility, and Cross Episode Financial Eligibility form, with the Subscriber Primary Identifier (2100C-NM1-09). | |
| Populate Subscriber Additional Identification (2100C-REF-02) With 'Subscriber Policy Number' | Select Yes to use the selected value in the Subscriber Policy # field in the Financial Eligibility and Cross Episode Financial Eligibility form, for the Subscriber Supplemental Identifier (2100C-REF-02). | This value is replaced when Medicaid Recipient Identification Number is selected in the Subscriber Additional Id Qualifier (270-2100C-REF-01) field, on the financial eligibility form. |
| Populate Subscriber Additional Identification (2100C-REF-02) With 'Subscriber's Social Security Number' | Select Yes to use the value entered in the Subscriber's Social Security # field Financial Eligibility and Cross Episode Financial Eligibility form, for the Subscriber Supplemental Identifier (2100C-REF-02). | This value is replaced when Social Security Number is selected in the Subscriber Additional Id Qualifier (270-2100C-REF-01) field, on the financial eligibility form. |
| Populate Subscriber Date (2100C-DTP) and Dependent Date (2100D-DTP)... | Select Yes to use the date entered in the Through Date field in the 270 Submission form, for the Subscriber Date (2100C-DTP) and the Dependent Date (2100C-DTP) segments. | |
| Populate Subscriber Eligibility/Benefit Date (2110C-DTP) and Dependent Eligibility/Benefit Date (2110D-DTP)... | Select Yes to use the date entered in the Through Date field in the 270 Submission form, for the Subscriber Eligibility/Benefit Date (2110C-DTP) and Dependent Eligibility/Benefit Date (2110C-DTP) segments. | |
| If The Subscriber Eligibility/Benefit Date... | When Yes is selected: The Subscriber Eligibility/Benefit Date (2110C-DTP) and Dependent Eligibility/Benefit Date (2110D-DTP) segments are bypassed when they are the same as the Subscriber Date (2100C-DTP) and Dependent Date (2100D-DTP) segments. | |
| Always Display The Following DTP Segment(s) In D8 (CCYYMMDD) Format | Select the segments to set in D8 format. |