Connecticut (Medicaid) - Quick Reference, What You Need to Know...
Search Options
-
Previously, this payer supported four search options. Now, this payer
supports only three search options.
1. Recipient ID, and Date of
Birth.
2. Recipient ID, and Social Security Number.
3. Social Security Number and Date of Birth.
- For
successful transaction processing, dependent data may be promoted to the
subscriber loop.
-
Connecticut Medicaid uses extra provider data within the 2100B loop.
This may include the Provider's City,
State, and Zip Code. The Provider’s Taxonomy Code is also preferred for
successful transaction processing.
Dates
-
Basically, there are no changes in date
rules.
-
This payer supports past dates back to
01/01/1800 and future dates up to the end of the current month.
There are no restrictions on date spans.
-
Inquiry dates now reference a Plan Date –
291 (DTP01), rather than Eligibility Dates - 307.
Response Data
Benefits
The following information is based on a
generic “Health Benefit Plan Coverage - 30” inquiry.
-
The
most notable difference is the 5010 response is that it utilizes
multiple service types, where as the
4010 response only used the service type of 30. This is most
apparent in the EB05 (Plan Description) for
the Service Descriptions.
-
The
Payer Name is now returned as “HP/CTMAP.”
-
The
Member’s address information is now returned.
-
The
Social Security Number is no longer returned in the response.
-
When
applicable, the Plan Begin Date is returned in the response.
-
Now,
“Qualified Medicare Beneficiary” is returned for the Plan Name
instead of “Medicare Covered Services.”
-
The
response now returns multiple service type codes in EB03.
Previously, the 4010 response only returned the service type code of
30.
-
The
Medicare Plan Coverage(s), TPP, and Service Providers are returned
in 2120C Loop using the NM1 segment.
Previously, the 4010 response used EB04 (Insurance Type Code) and
EB05 (Plan 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.