Buckeye (Medicaid) - Quick Reference, What You Need to Know...
Search Options
- This
payer supports three search options as listed below.
1. Subscriber ID.
2. Last Name, First Name, and Date of Birth.
3. Subscriber ID, Last Name, First Name, and Date of Birth.
-
For successful transaction processing, dependent data may be promoted to
the subscriber loop.
Dates
-
The inquiry uses the current date by
default.
-
No changes in date rules. However, inquiry dates
now reference a Plan Date - 291 (DTP01).
-
The response uses a Plan Begin Date – 346 (DTP01) in the
2110C Loop. Previously, the Benefit Date - 292
was returned.
Response Data
Benefits
The following information is based on a
generic “Health Benefit Plan Coverage - 30” inquiry.
-
The
5010 response now returns multiple service type codes in the
eligibility benefit loop (EB03).
-
The
5010 response now uses service type codes for Mental Health -
MH and
Urgent Care - UC.
-
Previously, this
information was returned in the 2110C Loop
using message segments
(MSG).
-
Each
2110C Loop for a specific Service Type Code contains a 2110C REF
Segment containing
the Plan Number and Description.
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.