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 an agreement with your state Medicaid office in order to have access to upload the 270. See your state workflow for details.

A quick recap of the directions below:

• To download the 270 claim eligibility query file, 
  • Click Scheduled
  • Click Check Client Eligibility
  • Click Generate 270 Eligibility Request
  • Save to Downloads (or other preferred location)
• To upload the 270 to your state portal,
  • Go to your state MMIS, such as EMOMED or https://www.njmmis.com
  • Upload the 270 file in the file management section
  • Download the 271 response when available
    • Note in Missouri this response is specific to the user who uploaded the 270
• Finally, to upload the 271 to Ankota,
  • Click Scheduled
  • Click Check Client Eligibility
  • Click Browse
  • Select the 271
  • Click Process File
  • View the response below (on the Ankota Check Client Eligibility page)
  • Download the file if desired (Excel format recommended)
  • View client status

This article includes the following sections:

Configuring an Eligibility Check

Building the Eligibility Check (270)

Uploading an Eligibility Check Response (271)

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:

• Go to Settings
• Click Services Settings
• Click Payer
• Click on a visit type
• Check the box next to Include in claim 270
• Do this for all payers as needed (private pay or grant funding would not be needed, for example)

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,

• Click Billing/Payroll
• Click Check Client Eligibility
• With the correct Eligibility Date entered and Funding Sources checked, click the Generate 270 Eligibility Request
• Download the file

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.