Expanded Recipient Eligibility Information Begins November 2

As a result of requests from providers, the response to recipient eligibility inquiries is being expanded to include additional information. Beginning November 2, 2014, NCTracks will return the Recipient's Category of Eligibility code (COE) and County Code for each enrollment span included in the eligibility verification response. (The County Code will be returned with the Recipient’s primary Benefit Plan only).

The COE and County Code will be reflected in the response to all forms of recipient eligibility inquiry, including the Automated Voice Response System (AVRS), the secure Provider Portal, and the 270/271 X12 transaction. The following response will be provided for each channel of recipient eligibility inquiry:
 
  • The AVRS will convey the values as ‘The eligibility coverage code is …’ and ‘The county is …’
  • The secure Provider Portal will display the County Code above the list of benefit plans and the Category of Eligibility will be displayed with its associated benefit plan.
  • For Trading Partners that receive an X12 response, the COE and County codes will be returned in the 271 Eligibility Response, Loop 2110C, MSG segment, with the headers “COE” and “COUNTY” followed by the codes.  
 
The 270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide has been updated and posted to the Trading Partner Information page on the NCTracks Provider Portal for additional information.