Program_Memos / 2002 / B-02-051

Why This Topic Matters

It helps Medicare stakeholders understand the scope of the 270/271 rollout, the supporting system and network changes, and the operational responsibilities tied to eligibility access, testing, and compliance.

Article Sections

1. Program Memorandum

   Introductory memorandum information from DHHS and CMS, including the transmittal and subject of the guidance.

2. X12 Documentation

   References to the applicable implementation guide and the general structure of the eligibility inquiry and response transaction.

3. Implementation Requirements

   System-wide implementation timing, transaction handling, connectivity approaches, and related responsibilities for Medicare claims processing environments.

4. Medicare Data Communication Network (MDCN)

   Network routing and access arrangements for eligibility traffic and the relationship to carrier-supported connectivity options.

5. CWF Modules Software

   CMS/CWF module responsibilities for eligibility processing, real-time response handling, audit support, and related software distribution.

6. Automated Response Unit (ARU) Requirements

   How ARU-based eligibility access fits into the broader implementation and how it relates to CWF-based data sources.

7. Direct Data Entry (DDE) Eligibility Access

   Requirements for direct data entry access, including continued availability, data source expectations, and screen maintenance considerations.

8. Inquiry and Response Information (270/271)

   General categories of data used in the inquiry and the broad types of information returned in eligibility responses.

9. Restricting and Controlling Access to Eligibility Information

   Conditions under which providers and their authorized agents may access eligibility data through supported channels.

10. Audit Trail Requirements

    Audit logging, provider-level monitoring, ratio reporting, and actions tied to unusual inquiry volume patterns.

11. CWF Data Flow Documents

    Supporting documentation available for carriers and interested entities related to the eligibility data flow and mappings.

12. Security Requirements

    Authentication, security file content, and validation responsibilities for submitters and data access controls.

13. Testing Implementation Schedule

    Production and testing milestones for CMS, standard systems, carriers, and external trading partners.

14. Provider and Clearinghouse Outreach -- What Carriers Must Tell Providers

    Required outreach topics carriers must communicate to providers, clearinghouses, and vendors about the new eligibility transaction environment.

15. Cost Issues

    Funding, budgeting, and cost-allocation considerations related to implementation, testing, and ongoing operation.