Affinity Health Plan (Commercial, Medicaid) - Quick Reference, What You Need to Know...
Search Options
- This
payer supports four search options as listed below.
1. Subscriber ID.
2. Social Security Number and Date of Birth.
3. Last Name, First Name, and Date of Birth.
4. Subscriber ID, Last Name, First Name, and Date of Birth.
-
For successful transaction processing, dependent data may be promoted to
the subscriber loop.
Dates
-
The inquiry requires both begin and end
dates.
-
No changes in date rules. However, 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.
-
Where
applicable, the 5010 response now uses service type codes for
Private Duty
Nursing Inpatient - CA, Private duty Nursing Outpatient - CB, Mental Health
Provider
Inpatient – CE, Durable Medical Equipment - DM, and Mental Health -
MH. Previously, this
information was returned in the 2110C Loop using message segments
(MSG).
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.