CoreSource (Little Rock) (TPA) - Quick Reference, What You Need to Know...
Search Options
-
No changes in search options or search criteria. This payer uses a
single search option.
The Patient Group Number is an optional field.
1. Subscriber ID, Patient
Last Name, Patient First Name, Patient Date of Birth, Patient Group
Number,
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
-
No changes in date rules. This payer
requires only the begin date for an inquiry.
-
This payer supports dates up to one year
in the past. No future dates or date spans are allowed.
-
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.
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.