Massachusetts State Seal
|
The Official Website of the Massachusetts Health Care Training Forum
Health Care Training Forum

Updated Message - Member Eligibility Response Logic Update

August 5, 2019

On July 28, 2019, MassHealth implemented a change to its member eligibility request response logic. The agency will no longer conduct an alternate search of its eligibility database when an invalid Member ID (MID) or Social Security Number (SSN) is submitted in the 270 HIPAA transaction or via the POSC. If a provider sends a 270 request with an invalid MID, the provider will receive a 271 response indicating “Invalid Member ID”. Specifically, it will state error code “72” Invalid/Missing Subscriber/Insured ID in the AAA03 - Reject Reason Code segment for Loop 2100C. POSC transactions will also receive a “Member ID Missing or not on file” response.

If you see one of these eligibility verification submission errors, this may be due to an invalid MID or SSN. It is important to review the rejection reason in the file and follow the resubmission instructions and other guidelines which can be found here:

https://www.mass.gov/service-details/eligibility-verification-system-overview.

MassHealth strongly recommends providers review their current eligibility inquiry practices today to ensure that you submit a valid MID on the request so that you do not receive unnecessary rejections.

If you have any questions regarding the member eligibility 270/271 batch transaction update, contact the MassHealth Customer Service Center at 1-800-841-2900 or edi@mahealth.net. If you are not the person within your organization that handles member eligibility, please forward this information to the appropriate staff within your organization or to your vendor.