Advantra AR, NM, TX (Commercial and Medicare) - Quick Reference, What You Need to Know...
Search Options
-
Previously, this payer supported five search options. Now, only three
search options are supported.
1. Subscriber ID.
2. Social Security Number and Date of Birth.
3. Last Name, First Name, and Group Number.
- For
successful transaction processing, dependent data may be promoted to the
subscriber loop.
Dates
-
Basically, no changes in date rules. This
payer uses a begin date for an inquiry.
The end date is optional.
-
This payer supports up to 18-months in the
past and up to three months in the future.
Up to a 90-day date span is also allowed.
-
Inquiry dates now reference a Plan Date –
291 (DTP01).
Response Data
Benefits
The following information is based on a
generic “Health Benefit Plan Coverage - 30” inquiry.
-
The 5010 response now uses service type codes for Mental Health – MH
and Urgent Care – UC.
-
The 5010 response now returns multiple service type codes in the
eligibility benefit loop (EB03).
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.