CMS just released version 5.6 of the 270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide for Mandatory Reporting Non-GHP Entities.

Changes in Version 5.6

The Part D Prescription Drug Enrollment Data (Table 27) has been updated to display the correct Segment IDs. Additionally, the date ranges for the Part C and Part D Enrollment and Termination Dates now include only a single dash instead of double dashes (Table 26 and Table 27).

The following will become effective December 11, 2021:

  • In 2020, the Provide Accurate Information Directly Act (PAID Act) was passed to help NGHP Responsible Reporting Entities (RREs) better coordinate benefits by providing additional beneficiary enrollment information.
    • With this Act, RREs will receive Part C (Medicare Advantage Plan) and Part D (Medicare prescription drug coverage) enrollment information for the past 3 years, as well as the most recent Part A and Part B entitlement dates.
    • To support this Act, the HIPAA Eligibility Wrapper (HEW) software will be updated and the X12 271 query formats will be modified to extract the additional fields (see 271 Eligibility Response Companion Document).

A PDF of the MMSEA Section 111 NGHP 270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide version 5.6 is posted on the NGHP User Guide page of CMS.gov.