Georgia
(Medicaid) - Quick Reference, What You Need to Know...
Search Options
- No
changes in search options or search criteria.
- For
successful transaction processing, dependent data may be promoted to the
subscriber loop.
Dates
-
Basically, no changes in date rules.
-
Dates now reference a Plan Date – 291
(DTP01) and are returned in a range format.
Date references for Eligibility – 307, as previously used in 4010
response are not returned.
Response Data
Benefits
The following information is based on a
generic “Health Benefit Plan Coverage - 30” inquiry.
-
The country code has been moved in the response.
Previously, it was provided in the Location ID (N4) segment. Now, it
is supplied in the Address2 (N3) segment.
-
Co-payment requirements have been moved in the response.
Previously, this was returned in the Co-Payment (EB01=B)
information. Now, it is supplied with the Benefit Description
(EB01=D) information. This is more logical since they do not send
the actual value of the co-pay, but only a message (MSG) with the
text indicating it may be required. This is not expected to result
in any processing issues.
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.