Default submission settings have been established for 270 eligibility transaction files that are sent to payors. Depending on the type of payor, agencies may need to complete additional setup in order for the Eligibility features to function properly. If no additional setup is completed, the software will use the following criteria outlined below to submit 270 files.
Payor ID
The payor ID used to verify eligibility may differ from the payor ID that is used on claims. If there is no payor ID override created for a payor, the software will use the claims Payor ID (as listed in Master Files | Payors / Plans | Payors) by default. To ensure that eligibility submissions are not rejected, ensure the correct payor ID is set up.
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It is likely that an override will need to be created for the eligibility payor ID. If you enable Eligibility (in Admission | System Control) and do not complete any additional setup, you may receive an “Invalid Participation Identification” error when submitting eligibility files (in Patients | Intake / Referral | Insurance | Eligibility) if a payor ID override is required. |
Benefit/Service Type Codes (STC)
By default, the software will submit a 270 request file for certain STC codes based on whether or not the payor is Medicare. The software will determine this by using the Payment Source field located in Master Files | Payors / Plans | Payors. The software will send all of the STC codes supported by Medicare (listed below) if the payor’s Payment Source is “Medicare A”. For all other payment sources, the software will only send a file for 30 by default.
● Non-Medicare: 30
● Medicare: 1, 2, 3, 4, 5, 6, 7, 8, 10, 12, 13, 14, 15, 18, 20, 23, 24, 25, 26, 27, 28, 30, 33, 35, 36, 37, 38, 39, 40, 41, 42, 45, 47, 48, 49, 50, 51, 52, 53, 54, 62, 65, 67, 68, 69, 73, 76, 78, 80, 81, 82, 83, 86, 88, 93, 98, 99, A0, A3, A4, A5, A6, A7, A8, AD, AE, AF, AG, AI, AJ, AK, AL, BF, BG, BH, BT, BU, BV, DM, MH, UC
Support of Multiple STC Codes in 270 Files
By default, the Include multiple service type codes box is checked in Master Files Payors / Plans Payors. This setting enables the software to submit multiple STC codes in each 270 transaction file, which is determined from the number that is entered in the Max per 270 field.
