Attention: NCTracks Trading Partners Service Limits Available Nov 1 in Eligibility Verification Response

Beginning November 1, 2015, DMA service limit data will be more readily available to providers. NCTracks will provide used and available service limit amounts on the eligibility verification response for the 270/271 X12 transaction for services used in the current fiscal year.

 

271 Health Care Eligibility Benefit Response: A number of segments in the 271 Health Care Eligibility Benefit Response, Loop 2110C, will be used for service limits. Trading Partners should refer to the 270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide on the Trading Partner Information page of the NCTracks Provider Portal for additional information on service limits.

  • The EB01 segment will have “F” for “Limitations,”
  • The EB03 segment, the service type code, will be set based on the service limit.
  • The EB05 segment will contain the literal “SVCLT” with a code appended at the end based on the service limit. Refer to Appendix A. 271 2110C EB05 Plan Coverage Descriptions of the 270/271 companion guide for service limit descriptions.
  • The EB06 segment qualifier will contain a “25” for the allocated service limit and a “29” for the remaining service limited
  • The EB07 segment will contain the dollar amount that will be returned for T1999 only
  • The EB09 segment will have “VS” for “Visits” for service limits other than T1999
  • The EB10 segment will contain the number of visits that were allocated/remaining for service limits other than T1999
  • The MSG01 segment will contain messages based on the service limit.  Please refer to 2110C, MSG01 segment of the 270/271 companion guide for specific service limit messages.    

Note: No service limit information is returned if no services have been counted against the limit.