Data Purge

In a continued effort to improve database efficiency, in February 2007, the Centers for Medicare & Medicaid Services (CMS) purged Medicare Beneficiary data that is older than 27 months from the eligibility database supporting the Medicare HIPAA Eligibility Transaction System (HETS) 270/271. Here are some examples of data purges that will occur:

• Part A and/or Part B entitlement periods with termination dates older than 27 months.

• Beneficiary records with a date of death greater than 27 months.

• Part B deductible information older than or equal to 3 years.

• Medicare Secondary Payer (MSP) records where other insurance coverage primary to Medicare has a termination date greater than 27 months.

• Managed Care Organization (MCO) enrollment records that have a termination date greater than 27 months.

• Home health episode history data where the episode has an end date greater than 27 months.

• Hospice periods where the termination date is greater than 27 months.

• Hospital and Skilled Nursing Facility (SNF) billing data where the data used for calculating deductible and days remaining for the benefit period have a date of latest billing activity (DOLBA) greater than 27 months.

• End Stage Renal Disease (ESRD) eligibility information with a termination date greater than 27 months.

Since eligibility information is designed to support the payment of claims, and the usual time limit for submitting claims is within 15 to 27 months of the date of service (depending on the month of service), the information source is purged quarterly of all data older than 27 calendar months. Medicare regulations allow an exception to the timely filing requirements in cases of the Medicare program's administrative error. In the rare situation where eligibility information older than 27 months may be needed, Provider Contact Centers (PCCs) are available to assist Providers or their representatives. The PCC representatives have access to the complete history of eligibility data from the source databases.

Effective 04/20/2007, to avoid misunderstandings and variations in responses, requests older than 27 calendar months are rejected with the error 2100C AAA03 = 62 – Date of Service Not Within Allowable Inquiry Period. CMS will compare the requested date on the 270 to the calculated date; based on the date the transaction was received by the CMS System minus 27 calendar months, to determine the eligibility window.

Again, this is just one of many steps CMS is taking to improve the Medicare Eligibility transaction. You can share your comments or concerns with CMS by contacting the MCARE Help Desk.

Medicare Customer Assistance Re: Eligibility (MCARE) Help Desk: 1-866-324-7315

TCP/IP Communication Transport Protocol Wrapper

Each submitted transmission shall contain one 270 transaction with only one ISA and IEA segment, along with a transmission wrapper around the 270 transaction. The transmission wrapper Header/Trailer has no Segment ID associated with it and requires the length of the transaction message. There will be no handshake after the connection is accepted with the first submitted transmission.

Outbound response transactions will have the same format transmission wrapper. The 271 response to the submitter will be returned in the same session in which the 270 was submitted.

Standard format of the TCP/IP Communication Transport Protocol Wrapper:

SOHLLLLLLLLLLSTX<HIPAA 270 Transaction>ETX

SOH = Required (1 positions), must be ASCII - 01

LLLLLLLLLL = Required (10 positions), Right justified with zero padded

Note: Length of the HIPAA 270 transaction not including Transmission wrapper data.

STX = Required ( 1 positions), must be ASCII - 02

<HIPAA 270 Transaction> = Required (HIPAA 270 – ISA-IEA)

ETX = Required (1 positions), Must be ASCII - 03

Note: For more details about SOH, STX and ETX see the Health Care Eligibility Benefit Inquiry and Response 270/271 ASC X12 Extended Control Set in the ASC X12 Standards for Transactions 270/271 004010X092A1 Implementation Guide.

See Downloads for a 271 Response example (with field explanation.)

Upcoming Enhancements

For the HETS 270/271, there are future enhancements planned based on user feedback. Some of these enhancements include adding additional data elements, as described in the document below. As implementation dates for these enhancements are scheduled, the table in the document will be updated.

See Downloads for a detailed list of requested enhancements, as they are available.

Downloads
271 Response Example[PDF,48KB]
Related Links Inside CMS
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Related Links Outside CMS
Current System Status: www.hetsstatus.com www.wpc-edi.com - Implementation Guides are available for download from this site.  Additionally, all code lists can also be obtained through this site.

Page Last Modified: 01/09/2009 2:04:47 PM
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