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TO: All Providers

RE: Upcoming Changes to Eligibility and Benefit Response 271 Transaction

Effective December 28, 2021, Alabama Medicaid will implement changes to the 271 Eligibility and Benefit Response transaction to ensure compliance with the Committee on Operating Rules for Information Exchange (CAQH CORE) for “Normalizing” the last name, which means removing all special characters, punctuation, upper case letters, suffixes, and prefixes to increase the chances of a match.

UPDATE: These changes are currently available in our test environment for Provider and Vendor testing. Testing should be completed by December 24, 2021.

As a Reminder:

This impact is related to the subscriber’s last name submitted in the 2100C - NM103 element for the 270 – Eligibility and Benefit Request. The normalization rule is only considered when the Last Name, First Name, and Date of Birth from the 270 request is used to locate the Medicaid recipient.

·   Existing Process - If the Medicaid stored last name DOES NOT match the 270 – NM103 submitted last name, the submitted last name will be normalized for matching on the Medicaid stored normalized last name.

·   New Process - If the 270-request normalized last name DOES match the Medicaid stored normalized last name, the correct ‘un-normalized’ last name will be returned in the 271 response – 2100C NM103 element. The 2100C INS segment will be returned indicating a change in the NM103 last name. 

· New Process - If the 270-request normalized last name DOES NOT match the Medicaid stored normalized last name, error code 73 (Invalid/Missing Subscriber/Insured Name) is returned in the AAA segment in place of error code 75 (Subscriber/ Insured Not Found).

Providers with questions concerning the upcoming change can submit them via the following email address: interChangeTesting@DXC.com.

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