The members address is now provided in most 5010 responses.
Response Data
Benefits
The following information is based on a generic “Health Benefit Plan Coverage - 30” inquiry.
This payer now provides the Member’s Address on most responses.
(This is a valuable enhancement from the previous 4010 response).In some cases, the Medicare payer information, including the HIC number is added to the 5010 response.
The message text “Urgent” has been removed and is designated by the proper Urgent Care – UC code.
Added service types for Hospital – 47 and Mental Health – MH.
Previously, the Legacy Provider ID was returned for a Primary Care Physician (PCP).
Now, the Primary Care Physician’s NPI is returned.In a few cases, benefit information is returned when the benefits are the same for both
an In Plan and Out of Plan Network, or when a Plan Network benefit does not apply.
This may occur regardless of the In Plan or Out of Plan Network designation. (EB12=W)Group Names that were previously returned in 4010 have different text descriptions in the 5010 response,
but have the same Group Number.