CoreSource Kansas (FMH) - Quick Reference, What You Need to Know...
Search Options
-
No changes in search options or search criteria. This payer now supports
the following 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.
Dates
-
This payer requires a begin date for an
inquiry. Previously, the current date was used by default.
-
This payer supports dates up to one year
in the past. Future dates and date spans are not 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.