Florida
(Medicaid) - Quick Reference, What You Need to Know...
Search Options
- No
changes in search options or search criteria. The Provider Specialty
remains an optional field.
- For
successful transaction processing, dependent data may be promoted to the
subscriber loop.
- The
Provider’s Taxonomy Code is optional, but should be established as extra
data.
The Provider’s Street Address, City, State, and Zip Code may also be
required.
Dates
-
This payer allows up to one year in the
past. No future dates allowed.
Previously, date spans were limited to one year. Now, there are no
restrictions on date spans.
-
The response provides a single Coverage
Date – 291. A date range is not returned.
Response Data
Benefits
The following information is based on a
generic “Health Benefit Plan Coverage - 30” inquiry.
-
The country code is not returned.
-
The service type for Long Term Care is not returned.
-
The response now provides new message text for indicating Qualified
Individual Beneficiaries,
and the word “PARTIAL” has been removed.
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.