2012-12-19

The Medicare 270/271 Eligibility system continues to return responses with higher than normal average response times. The vast majority of requests are receiving a proper 271 response from Medicare with a normal response time.  Some submitters are experiencing a high percentage of AAA03=42 time out responses.  If you are receiving time outs CMS recommends an interim measure of reducing the Date of Service span in your 270 request - this should result in a proper 271 response.
CMS has also identified that some HETS 270/271 submitters are misinterpreting components of the modified HETS 271 response following this weekend's release.  Please review the following notes to ensure that Medicare providers are receiving proper data:
1) HETS is now returning the coverage status of pharmacy coverage (Service Type Code (STC) = 88) in its own benefit loop.
As noted in Section 1.2 of the Q32012 Release Summary
When STC 88 (or STC 88 as component of STC 30) is requested, a separate specific coverage status 2110C loop is returned for STC 88 as follows:
• EB01=1 when the beneficiary has Part D plan coverage
• EB01=6 when the beneficiary does not have Part D plan coverage
It appears that some submitters are interpreting a pharmacy coverage EB01=6 and intepreting this as a general beneficiary inactive status for the entire set of STCs.  Please note that this coverage status information is specific to the patient's pharmacy coverage benefits.  Please ensure that your application is configured to correctly interpret and return the appropriate coverage status of Medicare benefits.

2) HETS is now returning multiple financial information 2110C loops on every 271 response where Part A entitlement exists.
As noted in Section 4.1 of the Q32012 Release Summary.
HETS is now returning the following financial information in 2110C loops on every 271 response where Part A entitlement exists:
• The base Part A deductible amount for each calendar year within the date/date range on the 270 request.
• The base Part A deductible amount for each calendar year of any intersecting inpatient spell(s). (Sent in an additional 2110C Loop)
• The remaining Part A deductible amount for each calendar year within the date/date range on the 270 request.
• The remaining Part A deductible amount for each calendar year of any intersecting spell(s). (Sent in an additional 2110C Loop)
• The remaining Part A deductible amount and applicable DOEBA/DOLBA dates for every spell that intersects the date/date range on the 270 request.
It appears that some submitters are erroneously interpreting the base financial data as actual patient usage spells that span the calendar year. Please note that base financial information will always be returned on every 271 response when Part A entitlement exists. If there is an active spell within the requested date range, that information will be returned in addition to the base information for the corresponding plan year(s). If the spell spans multiple years, base financial information for each year that intersects that spell will also be returned, regardless of the submitted date(s) in the request.
Further, base financial information will always be represented by a full calendar year date range (YYYY0101 – YYYY1231) in the DTP02 field. Spell information will typically be represented by a date range other than a full calendar year in the DTP02 field. In the rare instance that a spell runs from January 1st through December 31st, the sequential order of the returned loops should be used to differentiate base information from spell information.
The information returned in the 271 will always follow the same return order. Information is returned chronologically, with the most recent information being returned before older information. In addition, base information will be returned prior to spell information. Therefore, if there is an active spell to return, that information will always follow the base information for the corresponding year.