Assurant Health (Commercial) - Quick Reference, What You Need to Know...
(Time Insurance - FIC and Union Security Insurance - USIC)
Search Options
-
This payer now supports a combined single search option as shown below.
This inquiry now requires the relationship code. The subscriber social
security number is optional.
Previously, two search options were available.
One search for subscribers and the other search for dependents.
1. Subscriber ID, Patient
Last Name, Patient First Name, Subscriber Social Security Number,
Patient Date of Birth, and Relationship to Subscriber.
- This
payer does not promote dependent data. For this reason, it is necessary
for a transaction
to use either a subscriber or dependent loop, depending on the specified
value of the relationship code.
Dates
-
Basically, no changes in date rules. A
begin date is used for an inquiry.
-
This payer supports up to five years in
the past. No future dates or date spans are allowed.
-
Dates now reference a Plan Date – 291
(DTP01).
Previously, date references for Eligibility – 307 were used for the
inquiry.
Response Data
Benefits
The following information is based on a
generic “Health Benefit Plan Coverage - 30” inquiry.
-
Basically, there were no noteworthy differences between the 4010 and
5010 responses.
-
This
payer supports service type codes for Medical - 1, Health Plan
Benefit Coverage - 30,
Chiropractic - 33, Dental Care - 35, Hospital - 47, Emergency
Services - 86, Pharmacy - 88,
Professional Physician Office Visit - 98, Vision (Optometry) - AL,
Mental Health - MH, and
Urgent Care – UC.
-
By
default, the inquiry uses the generic “Health Benefit Plan Coverage
- 30” service type.
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.