If our production eligibility system does not currently maintain any member address information, do we have to make programming changes to add it so it can be returned on a 271 response.
Additional clarification was received from the submitter:
“Each beneficiary is assigned their own member ID so we have no dependent members linked to another member.”
Yes, you will need to make programming changes to return the subscriber’s address information in the 271 response (member’s address in your terminology).
The 005010X279 TR3 explicitly requires the subscriber’s address be returned in the 271 response when they are the patient (which would be the case for you since each individual is assigned their own unique member ID).
The 271 2100C N3 segment Situational Rule states “Required when the Subscriber is the patient or when the Information Source requires this information to identify the Subscriber for subsequent EDI transactions (see Section 1.4.7), but not required if a rejection response is generated and this segment was not sent in the request. If not required by this implementation guide, may be provided at sender’s discretion but cannot be required by the receiver.” A similar situational rule is used for the N4 segment.
Additionally, Section 1.4.7.1 states “If the individual is located in the information source's system, the following must be returned:” and 1.4.7.1 items 3 and 4 states “any other information (e.g. Address) required to identify the individual on subsequent EDI transactions (e.g. 837 Health Care Claim or 278 Health Care Services Review - Request for Review) must be returned. All three of the 005010 837 Claims TR3s (005010X222, 005010X223, 005010X224) require the subscriber’s address when they are the patient.