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Unsolicited Eligibility Dental Roster (U271)
Frequently Asked Questions (FAQs)

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.Q. Who do I contact if I have a question regarding receipt of my Aetna dental roster?.
.Q. What is a full file? What is a change file?.
.Q. Why is the data on the dental eligibility roster different from what is on the monthly Aetna DMO active patient roster?.
.Q. What fields will appear on terminated transactions?.
.Q. Will the dental roster file contain HMO members who have not selected a dental PCD office?.
.Q. What codes are used to define the members relationship to the subscriber on the dental member roster? .
.Q. What kinds of values will I find in coverage-level code? .
.Q. What information is contained in the plan code/plan name field and group/control number field?.
.Q. What information is contained in the Member ID field?.
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Q. Who do I contact if I have a question regarding receipt of my Aetna dental roster?
A. Questions regarding the pick-up or delivery of a dental member roster should be directed to the respective vendor customer support area. If the customer support area is unable to resolve an issue, it will be escalated to the EDI Assistance Center.

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Q. What is a full file? What is a change file?
A. A full file contains all the membership associated with an individual dental provider/PCD, including members which are active, new, terminated or have changed. A member who terminated since the last file will appear on the first subsequent full file and not on any future files.

A change file contains only those dental members associated with an individual dental provider/PCD who have changed since the last file was produced. A change file will contain change, addition and terminated transaction types. A member who terminated since the last file will appear on the first subsequent change file but not on any future files.

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Q. Why is the data on the dental eligibility roster different from what is on the monthly Aetna DMO active patient roster?
A. The two reports are not identical. They are generated from different Aetna-internal systems and produced on different schedules, so they do not reflect the same point-in-time view of the membership. The Aetna DMO active patient roster is supporting documentation for the provider’s monthly compensation report; the ANSI 271 dental eligibility roster is a point-in-time view of membership associated with an individual dental provider/ PCD.

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Q. What fields will appear on terminated transactions?
Termination records will return the data elements listed below:

  • Maint-type-code (=24)
  • Last name
  • First name
  • Middle initial
  • Member ID
  • Birth date
  • Gender
  • Medicaid number
  • Product code
  • Group number
  • Site code
  • Subgroup code
  • Self-insured indicator
  • Employer name
  • Employer city
  • Employer zip
  • All available ID numbers
  • Relationship code
  • Claim office code
  • PPID/plan summery
  • Plan begin date
  • Plan code
  • Cap office effective
  • Termination date
  • Cap office number

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Q. Will the dental roster file contain HMO members who have not selected a dental PCD office?
A. This membership will not appear on either type of dental roster. The dental member roster contains only those who have chosen a valid Aetna compensation office.

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Q. What codes are used to define the members relationship to the subscriber on the dental member roster?
A. On the file, the following values may be included:

  • Subscriber — 18
  • Dependent spouse — 02
  • Dependent child — 19

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Q. What kinds of values will I find in coverage-level code?
A. On the file, the following values may be included:

  • Children only — CHD
  • Employee and spouse — ESP
  • Dependents only — DEP
  • Employee and one dependent — EID
  • Employee and children — ECH
  • Employee only — EMP
  • Family - FAM
  • Individual - IND
  • Spouse and children - SPC
  • Spouse only – SPO

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Q. What information is contained in the plan code/plan name field and group/control number field?
A. For all dental products, the control/group name identifies the employer or other group in which the patient has obtained coverage. The plan code/name field identifies the plan of benefits in which the patient has coverage.

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Q. What information is contained in the Member ID field?
For members enrolled in an HMO plan with a dental rider, this data item will contain the Aetna HMO ID number. This is a unique ID assigned to subscribers and dependents.

For members enrolled in DMO plans, this data will contain the Aetna subscriber number. This is the number under which the family is enrolled in Aetna systems. All members of the family (subscriber and dependents) will have the same number.

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