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5010 Health Care Eligibility Benefit Inquiry and Response (270/271) Implementation Information

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Please Note: The 5010 Health Care Eligibility Benefit Inquiry and Response (270/271) is a process outside the scope of DHCS   MedCCC. This is information is being provided courtesy of DHCS MedCCC.

For more information, please visit HIPAA: 5010/NCPDP D.0 &1.2

or, for technical assistance, please call the Telephone Service Center (TSC) at 1-800-541-5555 ; and then push 1, 1, 4, 2. (outside of California, please call 916-636-1980)

Background

Below are links for the Medi-Cal 5010 Companion Guide and testing guidance that contain the 270 transaction; keep in mind that the Companion Guide is Medi-Cal specific and County Mental Health Plans (MHPs) will need to use the federal Technical Report Type 3 (TR3) as well to construct the HIPAA compliant 270 inquiry.

Links to Documentation

California Medicaid (Medi-Cal) Standard Companion Guide Transaction Information Instructions related to Transactions based on ASC X12 Implementation Guides, version 005010   HIPAA: HIPAA 5010 Companion Guide Released

The Companion Guides (CG) which comply with ASC X12N 5010 transaction standards contain the following two types of instructions:

  1. Communications/Connectivity Instructions Instructions for electronic communications with the publishing entity
    • The Communications/Connectivity component is included in the CG when the publishing entity wants to convey the information needed to commence and maintain communication exchange.
  2. Transaction Instructions Supplemental information for creating transactions for the publishing entity while ensuring compliance with the associated ASC X12 IG
    • The Transaction Instruction component is included in the CG when the publishing entity wants to clarify the IG instructions for submission of specific electronic transactions. The Transaction Instruction component content is limited by ASC X12’s copyrights and Fair Use statement.

Either the Communications/Connectivity component or the Transaction Instruction component must be included in every CG. The components may be published as separate documents or as a single document.

  1. ASC X12N 270/271 (005010X279A1): Real-Time Eligibility Benefit Inquiry/Response Testing                                              Back to Top

    HIPAA: Test Instructions: 270 Real-Time Eligibility Transactions

    1. The ASC X12N 270/271 Health Care Eligibility Benefit Inquiry and Response transaction is used to verify patient eligibility information of Medi-Cal recipients.
    2. This document contains all the information needed by a provider or vendor (submitter) to prepare, submit and evaluate a test transaction using either a National Provider Identifier (NPI) or a Medi-Cal provider number (for atypical providers).
    3. This ASC X12N 270/271 Health Care Eligibility Benefit Inquiry and Response transaction takes place electronically through either:
      • A Leased Line
      • Direct Data Connection (DDC)
      • Switch
      • Third Party Vendor, etc.
    4. Both testing and the successful completion of the 270 eligibility transaction is mandatory, whether for the first time or to upgrade to a new format such as 4010A1 to 5010.
    5. Once completed, the Real-time Internet Eligibility (RTIE) Benefit application will be available to submit production 270 Eligibility Benefit Inquiry transactions.

     

  2. ASC X12N 270/271 (005010X279A1): Batch Eligibility Transactions Benefit Inquiry/Response Testing

    HIPAA: Test Instructions: 270 Eligibility Batch Transactions
    1. The ASC X12N 270/271 Health Care Eligibility Benefit Inquiry and Response transaction is used to verify patient eligibility information of Medi-Cal recipients.
    2. This document contains the information needed by a provider or vendor (submitter) to prepare, submit and evaluate a test transaction using either a National Provider Identifier (NPI) or a Medi-Cal provider number (for atypical providers).
    3. Both testing and the successful completion of the 270 eligibility transaction is mandatory, whether for the first time or to upgrade to a new format such as 4010A1 to 5010.
    4. Once completed, the Batch Internet Eligibility application will be available to submit production 270 Eligibility Benefit Inquiry transactions.
                                                                                                                                                                                       Back to Top

Additional Information and Help Desk Contact Information

The 5010 Health Care Eligibility Benefit Inquiry and Response (270/271) is a process outside the scope of DHCS MedCCC.  For further information, please visit:   HIPAA: 5010/NCPDP D.0 & 1.2

To reach technical help at the Telephone Service Center (TSC), dial 1-800-541-5555; and then push 1, 1, 4, 2. (outside of California, please call 916-636-1980)

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Last modified on: 11/5/2015 11:18 AM