DC Mcaid

District of Columbia (Medicaid) - Quick Reference, What You Need to Know...

Search Options

Basically, there are no changes in search options. Now, the Social Security Number is used
with one search instead of three search options.

1. Provider, Begin Date, and Recipient ID.
2. Provider, Begin Date, Social Security Number, and Date of Birth.
3. Provider, Begin Date, Last Name, First Name, and Social Security Number.
4. Provider, Begin Date, Last Name, First Name, Date of Birth, and Sex.

For successful transaction processing, dependent data may be promoted to the subscriber loop.

Dates

Basically, there are no changes in date rules.
This payer uses a single begin date for an inquiry.
This payer supports 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.

Basically, there were no changes in the response.
The most notable difference is the 5010 response drops the word "Medicaid" from the
payer name. The Payer Name is now returned as District of Columbia. Previously, it was
returned as District of Columbia Medicaid.
This was a manual and visual comparison of response data.

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.