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TO:  All Providers


 


RE:  Upcoming Changes to
Eligibility and Benefit Response 271 Transaction


 


 


Providers:
Please pass this information along to your software vendors.


 


Effective December 14, 2021, Alabama Medicaid will
implement changes to the 271 Eligibility and Benefit Response transaction
to ensure compliance with the Committee on
Operating Rules for Information Exchange

(CAQH CORE)
for
“Normalizing” the last name, which means removing all special characters,
punctuation, upper case letters, suffixes, and prefixes to increase the chances
of a match.


 


What You Need to Know:


 


This impact is related to
the subscriber’s last name submitted in the 2100C – NM103 element for the 270 –
Eligibility and Benefit Request. The normalization rule is only considered
when the Last Name, First Name, and Date of Birth from the 270 request is used
to locate the Medicaid recipient.


 


·     Existing Process – If the Medicaid stored
last name DOES NOT match the 270 – NM103 submitted last name, the
submitted last name will be normalized for matching on the Medicaid stored
normalized last name.


 


·  New Process – If the
270-request normalized last name DOES match the Medicaid stored
normalized last name, the correct ‘un-normalized’ last name will be returned in
the 271 response – 2100C NM103 element. The 2100C INS segment will be
returned indicating a change in the NM103 last name. 


 


·     New Process – If the 270-request
normalized last name DOES NOT match the Medicaid stored normalized last
name, error code 73 (Invalid/Missing Subscriber/Insured Name) is returned in
the AAA segment in place of error code 75 (Subscriber/ Insured Not Found).


 


A User Acceptance testing
period will be available to providers to test the change. We currently anticipate
the testing period will begin in early October. Additional communications
regarding specific dates will be provided prior to the start of the testing
period. 


Although this notice serves
to communicate important changes coming soon to the Eligibility and Benefit 271
Response transaction, please continue to monitor the Alabama Medicaid website
at: www.medicaid.alabama.gov (including
Provider Insider newsletters and RA banner messages) for more detailed information
and implementation time frames.

Providers with questions concerning the upcoming change can submit them via the following email address: interChangeTesting@DXC.com.



 


The Current Procedural Terminology (CPT) and Current Dental Terminology
(CDT) codes descriptors, and other data are copyright © 2017 American Medical
Association and © 2017 American Dental Association (or such other date publication of CPT
and CDT). All rights reserved. Applicable FARS/DFARS apply.

 




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