AmeriHealth Administrators (TPA) - Quick Reference, What You Need to Know...
Search Options
1. Subscriber ID, Patient Last Name, Patient First Name, Patient Date of Birth, and Relationship to Subscriber.
2. Subscriber ID, Patient Last 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.
Dates
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 Physician Office Visit Sick BY,
Physician Office Visit Well BZ, Mental Health - MH, and Urgent Care UC.
The 5010 response now returns multiple service type codes in the eligibility benefit loop (EB03).
The response now uses a W indicator for both In Plan and Out of Plan Network (EB12=W).
Currently, the Co-Payment and Co-Insurance specifically identified as Mental Health is not returned.
When applicable, the contact information for the Utilization Management Organization (NM101=X3)
is now returned. (2120C/D Loop, PER Segment)