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Elizabeth M. Whitehorn, Director

Provider Notice issued 01/03/12

5010 271 Eligibility Response Transaction

​To:

Institutional Providers: Hospitals; Hospice Agencies; Ambulatory Surgical Treatment Centers; and Renal Dialysis Facilities​

​Date:

​January 3, 2012

​Re:

5010 271 Eligibility Response Transaction​

The Illinois Department of Healthcare and Family Services (HFS) would like to notify providers that HFS will eliminate the use of our proprietary eligibility response on January 4, 2012, that was utilized by the Recipient Eligibility Vendors (REV). The HFS proprietary eligibility response contained the eligibility System Date that identifies participant retroactive eligibility and the date that it was updated.

The Department of Human Services (DHS) does authorize medical coverage for any or all of the three months prior to the month of participant application, allowing retroactive eligibility. A claim will be considered for payment only if it is received by the department no later than 12 months from the date on which services or items are provided; however, one exception to this policy is retroactive eligibility. Providers can submit a paper claim, to their medical consultant, for payment consideration only if it is received by the department no later than 12 months from the "System Date."

The current 4010 version of the 270/271 Eligibility Request/Response Transactions and the 5010 version that HFS will be implementing on January 1, 2012, do not accommodate the reporting of the eligibility system date. HFS is in the process of making programming changes to report the system date in the 5010 271 Response Transaction. The following identifies where the system date will be reported once these changes have been made:

5010 271 Transaction

  • Loop 2110C, DTP Segment

  • Element DTP01 (Date/Time Qualifier) will contain the value 636 (Date of Last Update)

  • Element DTP03 (Date Time Period) will contain the System Date value.

The estimated completion time for these programming changes is February 1, 2012. Although the 4010 version will be available until April 1, 2012, HFS will not be making modifications to this version.

Until these programming changes can be made and implemented by the department, HFS recommends that providers hold all claims that are past timely filing as a result of retroactive eligibility. Once the programming has been implemented, providers can re-verify eligibility to identify the system date. HFS will consider payment for those claims that meet the system date criteria.

Any questions regarding this notice may be directed to the provider's medical assistance consultant in the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs