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Fields Enabled By Registry Settings - PM

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  • In the Reference Identification Qualifier 2 (2100B-REF-01) field, select the secondary reference ID type.

  • In the Information Receiver Additional Identifier 2 (2100B-REF-02) field, type the information receiver additional identifier.

  • In the License Number State Code 2 (2100B-REF-03) field, 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.

  • In the 'Populate Subscriber Name...' field, 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).

  • In the Populate Subscriber Additional Identification (2100C-REF-02) With 'Subscriber Policy Number' field, 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.

  • In the Populate Subscriber Additional Identification (2100C-REF-02) With 'Subscriber's Social Security Number' field, 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.

  • In the 'Populate Subscriber Date (2100C-DTP) and Dependent Date (2100D-DTP)...' field, 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.

  • In the 'Populate Subscriber Eligibility/Benefit Date (2110C-DTP) and Dependent Eligibility/Benefit Date (2110D-DTP)...' field, 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.

 

  • In the 'If The Subscriber Eligibility/Benefit Date...' field, 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.

  • In the 'Date To Display (2100C/2100D-DTP: 102-Issue)' field, the DTP segment of the
    2100C and 2100D loops of an 'Eligibility Inquiry (270) Submission' will be populated
    with the date specified in the field 'Subscriber's ID Card Issue Date' on the guarantor
    selection tab of the financial eligibility forms, or with the submission date respectively.
    These fields only appear when 270/271 HIPAA transaction sets are enabled and the
    registry setting 'Specify Subscriber/Dependent Date (2100C/2100D-DTP and 2110C/2110D-DTP'
    is set to Y.