The Centers for Medicare & Medicaid Services’ Benefits Coordination & Recovery Center (BCRC)  just released version 5.7 of the 270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide for Mandatory Reporting Non-GHP Entities.

Changes in Version 5.7

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 – Table 14, page 15).

For this release, the Part C Medicare Advantage and Part D Prescription Drug Enrollment Data 271 eligibility response file tables have been updated to display the correct Segment IDs for Element IDs NM101-103. Additionally, Part D contract information has been added (Table 26 and Table 27). Other changes have also been made to update and reorganize several tables.

A PDF of the MMSEA Section 111 NGHP 270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide version 5.7 is posted on the NGHP User Guide page of CMS.gov.