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CORE service level reporting for 270/271 scheduled to begin Sunday, Feb. 10 (not Jan. 27)
On Sunday, Feb. 10, the Division of Medical Assistance Programs (DMAP) plans to implement CORE Phase I and Phase II requirements, including service level reporting for the 270/271 transaction.
No changes are planned for Sunday. Jan. 27.
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Please do not send 270 requests for future dates of eligibility
Once we make these changes, please do not request any future-dated eligibility information from DMAP.
If you do request information for future eligibility dates, the 271 you receive may not accurately reflect the member’s current OHP eligibility.
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Clarifications about DMAP's 270/271 reporting
- OHA defines "in network" as "in state" and "out of network" as "out of state" (more than 75 miles outside the Oregon border).
- Please use DMAP's 271 to identify whether an OHP member is enrolled in a plan (MCO or CCO). For plan members, the provider will need to send an inquiry to the plan(s) listed in the 271 to find out details of coverage.
- For the 270 loop 2110C EQ segment, DMAP supports all mandated service types. For service types we do not support, we will respond as if a generic 30 were sent. For a list of all service types, see TR3 00510X279, page 125.
- For the 271 loop 2100C segment TRN03, we will not enforce the 1, 3 or 9 prefix, since that prefix is not required for the 270. We will send back what is sent to us and will not modify it. For more information, go to www.x12.org/x12org/subcommittees/x12rfi.cfm and search by RFI number 1272.
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