AARP
(Medicare) - Quick Reference, What You Need to Know...
Search Options
-
Previously, this payer supported two search options. Now, four search
options are supported.
The patient last name and first name are optional on the 2nd search.
1. Subscriber ID, Patient Last Name, Patient First Name, Date of Birth,
and Relationship to Subscriber.
2. Subscriber ID, Patient Last Name, Patient First Name, Patient Date of
Birth, and Relationship to Subscriber.
3. Subscriber ID, Patient Last Name, Patient First Name, and
Relationship to Subscriber.
4. Patient Last Name, Patient First Name, Patient Date of Birth, and
Relationship to Subscriber.
- This
payer does not promote dependent data. For this reason, it is necessary
for a transaction to use either
a subscriber or dependent loop, depending on the specified value of the
relationship code.
Dates
-
Basically, there are no changes to the
date rules. Both begin and end dates are used for an inquiry.
-
This payer supports up to 18 months in the
past. Future dates up to the end of the current month
are supported. No date spans are allowed.
-
Dates now reference a Plan Date 291 and
Plan Begin Date 346 (DTP01).
Previously, date references for Eligibility 307 were used and are no
longer returned.
Response Data
Benefits
The following information is based on a
generic Health Benefit Plan Coverage - 30 inquiry.
-
The 5010 response now returns multiple service type codes in the
eligibility benefit loop (EB03).
-
When applicable, the 5010 response returns new service type codes
for Mental Health MH
and Urgent Care UC.
-
The Payer Name is now returned as: AARP-UNITEDHEALTHCARE INSURANCE
COMPANY.
Disclaimer
This document is not intended to identify every scenario that may be
presented in the payer response.
It should
also be noted, that the payer response may vary depending on the search
criteria used in the initial inquiry.
Some content
is no longer returned in the X12 5010 271 response. In a similar fashion,
some content has been
modified and
new response information may be returned. Information that appeared
consistent between the
4010 and 5010
responses was not presented in this document.