Alabama
(Medicaid) - Quick Reference, What You Need to Know...
Search Options
-
Basically, no changes in search options or search criteria.
- For
successful transaction processing, dependent data may be promoted to the
subscriber loop.
- This
payer requires a Provider Taxonomy
Code, City, State, and Zip when a provider’s NPI is associated
with multiple addresses.
Dates
-
No changes in dates used. This payer
supports past dates up to the beginning of the previous year,
without restrictions on date spans. However, no future dates are
allowed.
-
Inquiry dates now reference a Plan Date –
291 (DTP01) and may be returned in a range format.
The ending date for an inquiry is optional.
Response Data
Benefits
The following information is based on a
generic “Health Benefit Plan Coverage - 30” inquiry.
-
This implementation is very similar to the previous 4010 version.
Coverage details are the same.
However, some minor differences were observed.
-
The member’s city, state, and zip code are now returned in the 5010
response.
However, the member’s street address is not returned.
-
The county code (in the N4 segment) that was previously in the 4010
response has been removed.
However, the county code is still presented in the plan text
description.
-
The member’s social security number has been removed. However, the
payer still returns the
HIC number for all patients with the SSN followed by “ZZZ” if the
patient is not actually a Medicare recipient.
-
The qualifier for Other Payer ID Numbers (2120C, NM1) has been
changed from ZZ (in 4010) to II (in 5010).
This corrects a problem with the 4010 use of codes.
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.