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Back  RFI # 412: 270/271 SSN Lookup

Formal vs. Informal Help Informal Formal


Ken Marrocco


In RI, the Department of Human Services (DHS) is the regulatory body for Medicaid. They outsource their IT functions to EDS. Recently EDS wanted to perform inquiries on our eligibility information so that they can determine if someone has Blue Cross insurance or if there was third party liability. There is also an additional need around child support. EDS asked us if we would accept the SSN as a search option. (please keep in mind that we do not assign a member's id by using their SSN).

My question: would we be out of compliance if we allowed EDS to send a 270 with SSNs instead of Subscriber IDs?


This issue is explicitly addressed in guide 004010X092. While the 2100C loop Subscriber NM1 segment element 08 does not support sending a qualifier identifying SSN as the ID in element 09, the REF segment (Subscriber Additional Identification) immediately following that NM1 segment does support an element 01 qualifier SY (Social Security number) that identifies that the number in element 02 is the SSN. It is acceptable to send the SSN in a 270 when it is not the Member ID as long as the REF segment is used and the SSN is not sent in the NM1 segment.

Section 1.3.8 Search Options offers additional information on Alternate Search Options which explicitly recognizes the SSN as a possible option.
Submission 5/26/2006
Status Date 7/10/2006
Status F - Final
Primary References
Document 004010X092
Set ID270