Harvard Pilgrim has made improvements to our 270/271 eligibility response transactions to make certain information more quickly and easily accessible for providers. The 270/271 eligibility response transaction now includes a “Y” or an “N” indicator to identify if a referral, authorization, or notification is required for each service type. There is no differentiation between the three — the “Y” or “N” listed covers all of them in one field.
Additionally, the eligibility response transaction now indicates that Medicare is the “Primary” coverage for coordination of benefits for Medicare Supplement, Medicare Enhance, and Med Enhance products. We continue to report other primary or secondary commercial insurance, if available.
Coming in October, the 270/271 eligibility response transaction will include a new service type for Newborn Nursery Non-Routine, which will be reported as “NI” (Neonatal Intensive Care). As is the case with all existing serving types, this new service type will also have a “Y” or “N” indicator to determine whether a referral, authorization, or notification is required for the service.
Please note that member eligibility and benefit information for Harvard Pilgrim’s StrideSM (HMO) Medicare Advantage products is available through our dedicated Medicare Advantage Provider Portal, and not through Harvard Pilgrim’s 270/271 eligibility response transaction.
If you have any questions about the eligibility response changes, please contact the Harvard Pilgrim EDI Team at EDI_team@harvardpilgrim.org or call 800-708-4414 (select option 1, then option 3).