Colorado
(Medicaid) - Quick Reference, What You Need to Know...
Search Options
- No
changes in search options or search criteria.
- For
successful transaction processing, dependent data may be promoted to the
subscriber loop.
Dates
-
No changes in date criteria.
-
This payer supports up to one year in the
past. No future dates are allowed.
There are no restrictions on date spans.
-
Under 5010, inquiry dates now reference a
Plan Date - 291 (DTP01).
Response Data
Benefits
The following information is based on a
generic “Health Benefit Plan Coverage - 30” inquiry.
This payer only responds to service type code “30.”
-
The 5010 data for this payer is very similar to the data returned in
the 4010 format.
However, the following exceptions were observed.
-
The county is no longer returned in the response.
-
The social security number is no longer returned in the response.
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.