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Back  RFI # 517: Medi-Cal 270/271 DTP Required

Formal vs. Informal Help Informal Formal

Submitter

Nicholas Davis

Description

To obtain patient eligibility information from California Medicaid’s 270/271 4010A1 system, Medi-Cal is Requiring a Card Issue Date in the 270 request. The Card Issue Date must be submitted at the subscriber level in a DTP segment, as defined in the Medi-Cal 270/271 companion guide (pg 27). Card Issue Date is a required field, and must exactly match the most recent Issue Date assigned for this patient in the issuance of the BIC. California Medicaid does not offer any alternate search options.

It is our interpretation that this required data element is non-compliant with 270/271 specifications as it is above and beyond the maximum data set allowed for an information source to verify eligibility, as defined in section 1.3.8 of the ASC X12 270/271 Guide.

Is this requirement compliant with current 270/271 specs?

Submitter Assigned Keywords

BIC, Issue Date, California Medicaid, DTP, Max Search Option, 270/271

Response

Guide 004010X092 explicitly addresses this issue. Section 1.3.8 states "If all four of these elements are present the information source must generate a response if the patient is in their database. All information sources are required to support the above search option." The elements referenced are Patient's member ID, last name, first name and date of birth. The health plan is required to respond with eligibility information and cannot require any additional information.

The card issue date can be sent if utilizing a different search option. The 2100C DTP01 Code value 102 (Issue) also contains further clarification which supports that a plan cannot require this date if the HIPAA Required Search option is used. The note on Code 102 state “Used if utilizing a search option other than the HIPAA search option identified in section 1.3.8 and is present on the identification card and is available.”
Submission 1/31/2007
Status Date 3/30/2007
Status F - Final
Primary References
Document 004010X091A1
Section1.3.8
Page21
Set ID270
Loop2100C
Segment Position120
Segment IDDTP
Element Position01
Component Position03
Industry NameProvider Advantage
External Code List102