AmeriHealth (Commercial) - 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. The 4th search option is unavailable, but may be added in the future.
Dates
Response Data
Benefits
The following information is based on a generic “Health Benefit Plan Coverage - 30” inquiry.
The 5010 response now returns the Patient’s Address. (2100C/D Loop)
The 5010 response now returns multiple service type codes in the eligibility benefit loop (EB03).
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 contact information for the Utilization Management Organization (NM101=X3) is now returned.
(2120C/D Loop, PER Segment)
The contact information for the Primary Care Provider (NM101=P3) is now returned.
(2120C/D Loop, N3, N4 and PER Segments)
Currently, the Co-Payment and Co-Insurance specifically identified as Mental Health is not returned.