I'd like to see an example of a complete Medi-Cal response that includes the 271 and 864 transactions. Is this possible?

You can view an example of a complete Medi-Cal response on pages 70 – 79 of the Webcast presentation for the 270/271 transactions.

The gender code is not an element that is valued in the 270 Inquiry transaction, and the subscriber address is not available in the file used by the eligibility verification system. Therefore, these data elements are not returned in the 271 Response transaction. However, you can accommodate your client's request by storing this information in your database and merging it into EDS's response before returning the 271 Response transaction to your client. To do this, you can use the BHT03 data element, which is a high-level trace number, to keep the 270 Inquiry and 271 Response transactions together. There are also two TRN segments that can be used for this purpose—one for the provider and one for the submitter. These segments are trace numbers at the subscriber level. Lastly, there is an REF segment in the 270 Inquiry transaction that can be populated with an REF01 qualifier of “EJ” (Patient Account Number), which must be returned with the 271 Response transaction if received as part of the 270 Inquiry transaction. Any of these data elements can be used to correlate the 270 Inquiry and 271 Response transactions.

Will the 270/271 real-time transactions be the only way to check eligibility?

No. Real-time eligibility can also be checked using the Automated Eligibility Voice System (AEVS), a Point of Service (POS) device or the Internet via the Real-Time Internet Eligibility (RTIE) Single Subscriber or Multiple Subscriber application. In addition, Medi-Cal is currently developing an Internet Batch Eligibility transaction, which is expected to be available by Summer 2005.  More information will be available on the Medi-Cal Web site in early 2005.

Will the DTP01 date qualifier “102” (issue date) be returned in the 271 Response transaction if it was not included in the 270 Inquiry transaction? If so, what segment will it be in on the 271 Response transaction?

If the 2100C DTP segment is missing on the 270 Inquiry transaction, the transaction will not be processed and an error will be returned in the 271 Response transaction indicating that the DTP segment is missing. Even though the Implementation Guide indicates that this as a situational segment, the Issue Date is currently required by the Medi-Cal Eligibility Verication System (however, the Department of Health Care Services [DHS] is in the process of changing this requirement).

For a valid inquiry, the issue date will be in the 2100C DTP segment if returned in the 271 Response transaction. This segment is a situational segment, and the situational rule is that if DHS returns this information to EDS, then EDS will format it in the 2100C loop. This data element is not mandatory.

Please provide more information regarding connectivity. I think we will be able to generate a 270 Inquiry transaction data set as specified in the Webcast presentation, but where and how do we submit the transaction?

If you are currently submitting 270 Inquiry transactions in the 30xx format and are upgrading to the new 4010/4010A1 formats, there is no change in connectivity. However, if you are submitting 270 Inquiry transactions for the first time, you need to review the 270/271 Companion Guides.

Medi-Cal has subscribers only, not dependents. If the information is entered at the dependent level and the information at the subscriber level is blank or incorrect, the 270 Inquiry transaction is invalid and no processing occurs. However, if the subscriber-level information is a duplication of the dependent-level information, processing continues and the information at the lower dependent level is ignored.

We are required to provide the Medi-Cal card issue date in the 270 Inquiry transaction. If we do not know the actual issue date, can we provide the current date in the DTP segment of the 2100C loop (with DTP01="102")?

No. The actual issue date from the subscriber's Medi-Cal identification card is required for this data element. If you do not know the card issue date, you should either contact the subscriber to obtain it or use the Automated Eligibility Verification System (AEVS) by calling 1-800-456-2387.

How different is the 270 Real-Time Internet Eligibility (RTIE) transaction from the one being used now on the Medi-Cal Web site?

There is no difference in terminology, however there is a difference in the connectivity mode. For real-time eligibility inquiries, the Internet is considered a Direct Data Entry (DDE) device and follows the DDE rules for format and content. The real-time inquiry transaction discussed in the Webcast presentation is for leased-line and Inter-System Communication (ISC) connectivity. These two connectivity modes are usually mainframe-to-mainframe or online transaction processor-to-EDS's CICS online transaction processor modes. These two modes are the first 270 Inquiry transaction modes to be upgraded to the HIPAA-required 4010/4010A1 formats.