270/271 HIPAA Transaction Validation (Pre-Query and Post-Query) (Washington State Health Care Authority)
270/271 HIPAA Transaction validation (Washington State Medicaid’s 270/271 transaction) will perform a pre-query validation to make sure the required Subscribe data elements are preset prior to routing the information to Eligibility and Benefit system. For Subscriber request below data elements can be submitted:
- 2100C/NM109 Subscriber ID (Client ID) and
- 2100C/NM103 Subscriber Last Name and
- 2100C/NM104 Subscriber First Name and
- 2100C/DMG Subscriber Date of Birth (DOB)
- 2100C/REF Social Security Number (SSN)
Below are the applicable client eligibility search options:
- Client ID
- Full Name, DOB
- Full Name, SSN
- SSN, DOB
- Client ID, Full Name, DOB
- Client ID, Last Name, DOB
- Client ID, Last Name
AAA error codes will be sent out as defined in the CORE guidelines. Multiple AAA segments can be returned based on invalid or missing data elements.
Post-Query validation
Once the Pre-Query validation is completed a Post Query validation will be performed. During Post Query validation, the system will match the below mentioned Subscriber elements against the Washington State Medicaid’s Eligibility and Benefit’s System:
- 2100C/NM109 Subscriber ID (Client ID) and
- 2100C/NM103 Subscriber Last Name and
- 2100C/NM104 Subscriber First Name and
- 2100C/DMG Subscriber DOB and
- 2100C/REF SSN
If a proper match is found the system will return an Eligibility Response otherwise AAA error codes will be sent out as defined in the CORE guidelines. Multiple AAA segments can be returned based on the missing or invalid data elements.
Rejected Transmissions and Transactions
270 transactions will be rejected if the file does not meet HIPAA standards for syntax, data integrity and structure (Strategic National Implementation Process (SNIP) type 1 and 2). Additionally, the transactions will be validated against HCA defined custom rules (SNIP type 7) as specified in the Transaction Specification section. Non-compliance of the custom rules will result in rejection of the transaction.