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TO: All Providers


 


RE: Upcoming Changes to Eligibility and Benefit Response
271 Transaction


 


 


Effective December 28, 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.


 


UPDATE: These
changes are currently available in our test environment for Provider and Vendor
testing. Testing should be completed by December 24, 2021.


 


As a Reminder:


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).


 


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 © 20
21
American Medical Association and © 20
21 American Dental Association (or such other date publication of CPT
and CDT). All rights reserved. Applicable FARS/DFARS apply.




 


 


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