270/271 Technical Conference Call

On behalf of our members, VHCA has requested that the Department of Medical Assistance Services (DMAS) send nursing facilities a monthly enrollment roster of their residents and patients who are enrolled in the Commonwealth Coordinated Care (CCC) program.  The DMAS real-time, web-based, automated response system (ARS) limits the provider’s verification submission to 10 members at a time.  DMAS has indicated that the Department does not have the system resources to be able to provide an enrollment roster to all interested providers each month.  However, DMAS has determined that a method for checking the eligibility/enrollment for up to 999 members at a time exists through the 270/271 HIPAA transaction, which is an industry standard method for supplying this type of information.  

The 270/271 is the HIPAA compliant electronic eligibility benefit inquiry and response transaction.  This transaction includes eligibility and managed care enrollment data.  It also includes TPL and service limit information.  The DMAS 271 response gives back info for up to a year back and one month forward (when sent after the monthly managed care assignment cycle that runs on the 18th).  For DMAS, the 270/271 is handled through Xerox, DMAS’ Fiscal Agent.  Detailed information on the 270/271 transaction and submission requirements is available on the Virginia Medicaid Web Portal at: https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/ in the 270/271 EDI Companion Guide, under the EDI Support tab (EDI Companion Guides).

A conference call to provide technical assistance to information technology professionals within your organizations or to contracted IT vendors related to extracting beneficiary CCC and MMP enrollment status information using the 270 / 271 transaction set will be held on Monday, June 23rd at 1 PM.  This call will be hosted by DMAS along with their fiscal agent, Xerox.  The dial-in number for this call is 866.842.6779 and the PIN is 5904744355.  Please note that this call is intended only for technical staff that will be responsible for possible programming modifications needed to access the CCC/Medicare-Medicaid Plan assignment and status information.