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270/271 HIPAA Transaction (MAHP/HC Guidelines)

MAHP/HC’s Trading Partners must adhere to the following business rules and limitations for submitting transactions in real time:

  • Only one patient per transaction.
  • Only one transaction per functional group.
  • Only one functional group per interchange.
  • Interchange acknowledgements for successful deliveries will be honored for submitters using the dual-port method.
  • If no date of service is received, the current date (based on Central time) will be considered as the date of service.

Acknowledgements and reports

As the 270 transaction is designed to be exchanged for a 271 response containing the benefit information sought in the 270 request, Change HealthCare will not send any other sort of acknowledgement that the 270 has been received, unless there is a problem processing the request. Should the 270 fail structural validation upon receipt, a 999 acknowledgment file will be returned detailing the specific errors. No 271 response will be generated unless the 270 is corrected and resubmitted.

Trading Partners

An EDI Trading Partner is defined as any MAHP/HC customer (provider, billing service, software vendor, employer group, financial institution, etc.) that transmits to or receives electronic data from MAHP/HC. Payers have EDI Trading Partner Agreements that accompany the standard implementation guide to ensure the integrity of the electronic transaction process. The Trading Partner Agreement is related to the electronic exchange of information, whether the agreement is an entity or a part of a larger agreement between each party to the agreement. For example, a Trading Partner Agreement may specify among other things, the roles and responsibilities of each party to the agreement in conducting standard transactions. As MAHP/HC only will be directly exchanging data with Change HealthCare, the existing Trading Partner Agreement between MAHP/HC and Change HealthCare will cover these transmissions. It may be necessary for those originating these transactions to complete similar documents with Change HealthCare.

To learn more about EDI and become a certified EDI Professional, please visit our course schedule page.

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