AUC Eligibility TAG

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Maintain a standard, uniform common companion guide for the eligibility transaction (270/271) (pursuant to Minn. Stat. § 62J.536), covering topics such as:

• Search options
• Rejected transaction reporting
• Loops/segments and data elements
• Usage of situational data elements

Identify and document common business best practices related to the Eligibility Inquiry/Response transaction for the Minnesota community.

Work with Minnesota payers, providers and employers to determine ways to reduce administrative costs within the community through timely, accurate reporting of changes to member coverage.

Created a standard, uniform common companion guide for the eligibility transaction (270/271) (pursuant to Minn. Stat. § 62J.536).

The TAG will:

• Review work done by CMS, other states, and national organizations.
• Review and provide input on HIPAA Technical Report Type 3 documents, both current and future versions.
• Determine if any data elements are missing, not needed or in need of clarification from the HIPAA Technical Report Type 3 documents.
• Determine the best approach for Minnesota (i.e. Minnesota Companion guide, best practice).
• The companion guide must comply with all applicable Minnesota and federal regulations, including 45 CFR Parts 160, 162, and 164 (HIPAA Administrative Simplification, including adopted federal operating rules) and related ASC X12N and retail pharmacy specifications (ASCX12N and NCPDP implementation specifications).

A standard, uniform companion guide entitled, ASCX12/005010X279A1 Health Care Eligibility Benefit Inquiry and Response (270/271).

Eligibility inquiry and response transaction best practices.