Eligibility/Benefit Inquiry and Response (270/271)

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Questions




If you have questions or need assistance, call our Provider Relations Department at:

1-714-246-8600

Monday through Friday from 8 a.m. to 4 p.m. Pacific Time

When do Providers Use Eligibility and Benefit Inquiry and Response?

EDI Health Care Eligibility/Benefit Inquiry (270) is what health care service providers use to inquire about the health care eligibility and benefits associated with a CalOptima member.

The 270 transaction allows the health care service provider to inquire about a member’s eligibility and benefit information.

The 270 transaction typically includes the following:

  • Details of the sender of the inquiry (name and contact information of the information receiver)

  • Name of the recipient of the inquiry (the information source)

  • Details of the CalOptima member, related to the inquiry

  • Description of eligibility or benefit information requested

Providers use the 270 transaction in conjunction with the EDI 271 transaction. The 271 is the Health Care Eligibility/Benefit Response used to transmit the information requested in a 270.

EDI Health Care Eligibility/Benefit Response (271) is how CalOptima responds to a provider’s request for eligibility and benefit information for a member. Its intention is not to provide a complete representation of all benefits, but rather to address the status of eligibility, benefit information and member financial responsibility, when applicable.

CalOptima sends the 271 transaction in response to the 270 inquiry from a health care service provider that contains eligibility and benefit information for a member.

The 271 transaction typically includes the following:

  • Details of the sender of the inquiry (name and contact information of the information receiver)

  • Name of the recipient of the inquiry (the information source)

  • Details of the CalOptima member, related to the inquiry

  • Description of eligibility or benefit information requested

The 271 response returned by CalOptima should not be interpreted as a guarantee of payment. Payment of benefits remains subject to all health plan benefit terms, limits, conditions, exclusions and the member’s eligibility at the time providers render services.

What Are The Benefits?

Electronic eligibility verification may result in the following benefits:

  • Reduced collection and billing costs

  • Decreased bad debt

  • Improved cash flow

  • Increased productivity and efficiency

  • Fewer rejected claims

  • Less time spent on manual, administrative tasks

  • Expedited reimbursement

Providers can perform eligibility (270/271) transactions in real-time mode, based on connectivity method.

Getting Started

For an overview of how this process works and the user agreements that may be required prior to activation, visit the Office Ally website for Eligibility/Benefit request.

If you have questions about real-time transactions, contact the Office Ally Customer Service department at 360-975-7000.

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