1. Subscriber ID, Patient Last Name, Patient First Name, Patient Date of Birth, Patient Sex,
and Relationship to Subscriber.
Dates
Response Data
Benefits
The following information is based on a generic Health Benefit Plan Coverage - 30 inquiry.
The Group Number is now returned.
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 5010 response now returns service type codes for Chiropractic 33 and Pharmacy 88
where applicable.
An inquiry with service type code for Mental Health MH, is needed to receive Mental Health
benefit details including deductibles, co-insurance, co-payments, and provider information. (EQ01=MH)
For Primary Payer, TTP, or PCP, the telephone number is now returned using the proper PER segment.
Previously, this was returned in the Last Name data field.
For SENIOR SECURITY plans, the Member ID and Primary Payer name is being returned.
For SENIOR SECURITY plans, neither the Plan Name nor the Eligibility Date is returned.
This payer has stopped using the U designation for In Plan and Out of Plan Network (EB12=U).
Now, they extensively use a W for both In Plan and Out of Plan Network (EB12=W).