MN HIPAA

Collaborative

270/271 Eligibility Benefit Inquiry and Response
MN HIPAA Companion
Guide 004010X092A1 Instruction

The Minnesota HIPAA Collaboration has developed an “implementation specification” spreadsheet to assist providers, payers, clearinghouses and other vendors in the implementation of the 270/271 Eligibility Benefit Inquiry and Response transactions. This document includes the specific data edits and/or requirements for the participating entities. Some additional information concerning the use of this spreadsheet:

1. This was developed using Microsoft Excel 97.

2. This is based on the X12N May 2000 Implementation Guide (004010X092). This information has been updated to include the Addenda to the Implementation Guides (004010X092A1).

3. Information in this spreadsheet includes:

· Specific data conditions that must be met for each Payer

· Specific qualifier(s) that are recommended for processing

· Notes regarding which segments and elements are not utilized by the Payers, and therefore will not be sent to the provider.

· Notes regarding the search criteria (270 transaction) utilized by the Payers, and also notes regarding the data included in the response transaction (271).

4. This document does not include information concerning Required segments, elements and/or data conditions. It is the expectation of all entities that required segments, elements and data conditions will be included in every transaction. This spreadsheet must be utilized with the official HIPAA Implementation Guide (004010X092) and Addenda (004010X092A1) published by Washington Publishing Corporation.

5. If a Provider/Payer (submitter) chooses to send segments or data elements where the receiver has indicated “Not used”, the valid HIPAA code sets must be utilized to meet compliance.

6. Rules applying to an entire segment are noted at the segment level and are in bold.

7. Connectivity information (ISA/IEA, GS/GE) is not included in this spreadsheet. Please refer to the Connectivity Profiles for this information.

8. If you have any questions concerning a Payer’s information, please refer to the Testing Profiles for contact information.