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Eligibility Checks for Insurance Coverage

Overview

Eligibility checks for insurance can be done through a 270 file, a client eligibility query file, which can be turned on in environments if desired. After downloading the 270 from Ankota, the file can be uploaded to a Medicaid state portal and a 271 (client eligibility status file) will be returned to the user. Then the 271 file will be uploaded into Ankota and the client's eligibility can be reviewed.

NOTE: In some states, you will need to sign a Trading Partner agreement with your state Medicaid office in order to have access to upload the 270. (You probably already have one in place if you upload 837s to your state portal.) See your state workflow for details.


This article includes the following sections:

General Process

Further Details

Configuring an Eligibility Check

Building the Eligibility Check (270)

Uploading an Eligibility Check Response (271)


General Process

PREP


LIVE PROCESS


Further Details

Configuring an Eligibility Check

To ensure payers are linked to the 270 file, a superuser or Ankota specialist should configure the eligibility check. 

This can be done as follows:



Once payers have been linked to the 270, you can access the report as needed. 


Building the Eligibility Check (270)

To build the 270 report,


This file should be uploaded in your usual insurance portal. 


Uploading an Eligibility Check Response (271)

The reply "271" can be uploaded once it is received in the same location. Once uploaded, it will publish the results below the upload portal for your review.